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Villain C, Ebert N, Glassock RJ, Mielke N, Bothe T, Barghouth MH, Pöhlmann A, Fietz AK, Gill JS, Schaeffner E. Medical Suitability and Willingness for Living Kidney Donation Among Older Adults. Am J Kidney Dis 2024:S0272-6386(24)00983-1. [PMID: 39362396 DOI: 10.1053/j.ajkd.2024.07.010] [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: 03/27/2024] [Revised: 07/04/2024] [Accepted: 07/17/2024] [Indexed: 10/05/2024]
Abstract
RATIONALE & OBJECTIVE The benefits of kidney transplantation compared to treatment with dialysis, including in older adult, are primarily limited by the number of donated kidneys. We studied the potential to expand the use of older living kidney donors. STUDY DESIGN Secondary analysis of the Berlin Initiative Study, a population-based cohort. SETTING & Participants: 2069 adults aged ≥70 years in Germany. EXPOSURES Age and sex. OUTCOMES Suitability for living donation assessed by the absence of kidney-related exclusions for donation including albuminuria and low estimated glomerular filtration rate (eGFR) as well as absence of other medical exclusions. Willingness for living and deceased kidney donation assessed by participant survey. ANALYTICAL APPROACH Descriptive analysis. RESULTS Among the 2069 participants (median age 80 years, 53% women, median eGFR 63 ml/min/1.73m2), 93% had ≥1 medical contraindication for living donation at study entry unrelated to eGFR or albuminuria. Using two published eGFR and albuminuria thresholds for donor acceptance, 38% to 54% of participants had kidney-related exclusions for donation. Among the 5% to 6% of participants with neither medical nor kidney-related exclusions for living donation at baseline, 11% to 12% remained suitable for donation during 8 years of follow-up. Willingness for living or deceased donation was high (73% and 60%, respectively). LIMITATIONS GFR was not measured and medical exclusions unrelated to eGFR and albuminuria were assessed using a cohort database complemented by claims data. CONCLUSIONS One in twenty older adults were potentially suitable for living kidney donation and willingness for living donation was high. Further studies are warranted to define the feasibility of expanding living kidney donation among older adults.
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Affiliation(s)
- Cédric Villain
- Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany; Normandie Univ UNICAEN, INSERM U1075 COMETE, service de Gériatrie, CHU de Caen, Caen, France
| | - Natalie Ebert
- Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Richard J Glassock
- Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Nina Mielke
- Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Tim Bothe
- Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Muhammad Helmi Barghouth
- Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Anna Pöhlmann
- Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Anne-Katrin Fietz
- Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany
| | - John S Gill
- Division of Nephrology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Elke Schaeffner
- Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany
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Ryan RJ, Bentall AJ, Issa N, Dean PG, Smith BH, Stegall MD, Riad SM. Outcomes of Older Primary Kidney Transplant Recipients by Induction Agent and High-risk Viral Discordance Status in the United States. Transplant Direct 2024; 10:e1698. [PMID: 39328252 PMCID: PMC11427033 DOI: 10.1097/txd.0000000000001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 09/28/2024] Open
Abstract
Background The impact of induction type or high-risk viral discordance on older kidney transplant recipients is unclear. Herein, we analyzed the association between induction type, viral discordance, and outcomes for older recipients. Methods We analyzed the Scientific Registry of Transplant Recipients standard analysis file for all primary kidney transplant recipients older than 55 y who were transplanted between 2005 and 2022. All transplants were crossmatch negative and ABO-compatible. Recipients were discharged on tacrolimus and mycophenolate ± steroids. Recipients were categorized into 3 groups by induction received: rabbit antithymocyte globulin (r-ATG; N = 51 079), interleukin-2 receptor antagonist (IL-2RA; N = 22 752), and alemtuzumab (N = 13 465). Kaplan-Meier curves were generated for recipient and graft survival, and follow-up was censored at 10 y. Mixed-effect Cox proportional hazard models examined the association between induction type, high-risk viral discordance, and outcomes of interest. Models were adjusted for pertinent recipient and donor characteristics. Results Induction type did not predict recipient survival in the multivariable model, whereas Epstein-Barr virus high-risk discordance predicted 14% higher mortality (1.14 [1.07-1.21], P < 0.01). In the multivariable model for death-censored graft survival, alemtuzumab, but not IL-2RA, was associated with an increased risk of graft loss (1.18 [1.06-1.29], P < 0.01) compared with r-ATG. High-risk cytomegalovirus discordance predicted 10% lower death-censored graft survival (1.10 [1.01-1.19], P < 0.02). Live donor and preemptive transplantation were favorable predictors of survival. Conclusions In this large cohort of older transplant recipients, alemtuzumab, but not IL-2RA, induction was associated with an increased risk of graft loss compared with r-ATG. Cytomegalovirus and Epstein-Barr virus high-risk viral discordance portended poor graft and recipient survival, respectively.
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Affiliation(s)
- Randi J Ryan
- Division of Transplant Surgery, Intermountain Health, Murray, UT
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Andrew J Bentall
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Naim Issa
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Patrick G Dean
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Byron H Smith
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Mark D Stegall
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Samy M Riad
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
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Savoye E, Santin G, Legeai C, Kerbaul F, Gaillard F, Pastural M. Comparison of Kidney Graft Function and Survival in an Emulated Trial With Living Donors and Brain-Dead Donors. Transpl Int 2024; 37:13208. [PMID: 39267619 PMCID: PMC11391114 DOI: 10.3389/ti.2024.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/25/2024] [Indexed: 09/15/2024]
Abstract
Living donation (LD) transplantation is the preferred treatment for kidney failure as compared to donation after brain death (DBD), but age may play a role. We compared the 1-year estimated glomerular filtration rate (eGFR) after kidney transplantation for recipients of LD and DBD stratified by recipient and donor age between 2015 and 2018 in a matched cohort. The strength of the association between donation type and 1-year eGFR differed by recipient age (P interaction < 0.0001). For LD recipients aged 40-54 years versus same-aged DBD recipients, the adjusted odds ratio (aOR) for eGFR ≥60 mL/min/1.73 m2 was 1.48 (95% CI: 1.16-1.90). For DBD recipients aged ≥ 60 years, the aOR was 0.18 (95% CI: 0.12-0.29) versus DBD recipients aged 40-54 years but was 0.91 (95% CI: 0.67-1.24) versus LD recipients aged ≥60 years. In the matched cohort, 4-year graft and patient survival differed by donor age and type. As compared with DBD grafts, LD grafts increased the proportion of recipients with 1-year eGFR ≥60 mL/min/1.73 m2. Recipients aged ≥60 years benefited most from LD transplantation, even if the donor was aged ≥60 years. For younger recipients, large age differences between donor and recipient could also be addressed with a paired exchange program.
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Affiliation(s)
- Emilie Savoye
- Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - Gaëlle Santin
- Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - Camille Legeai
- Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - François Kerbaul
- Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - François Gaillard
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Myriam Pastural
- Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, Saint-Denis La Plaine, France
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Gruessner RWG, Gruessner AC. The Centennial Allograft: Cumulative Kidney and Liver Function for More Than 100 Years. Transplant Proc 2024; 56:1341-1346. [PMID: 39003206 DOI: 10.1016/j.transproceed.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/25/2024] [Indexed: 07/15/2024]
Abstract
The maximum cumulative life span of kidneys and livers first in donors and then in transplant recipients has not been established. The purpose of this study was to determine if cumulative organ function for more than 90 years is possible for transplanted kidneys and livers. This study included kidney and liver transplants from living or deceased donors ≥55 years. Cumulative organ function (COF) = Organ Age at Donation [Years] + Tx Allograft Function [Years]. Univariate and multivariable methods were used to describe characteristics and outcomes. Between 1987 and 2022, a total of 81,807 kidney and 37,099 liver transplants were included in this study. Of all kidney grafts 2.7% but 16.6% of all liver grafts reached the 90-year COF mark. There were only 2 living donor kidneys that surpassed the 100-year mark versus 29 deceased liver grafts. The longest kidney function was 104 years and longest liver function 108 years. Multivariate analysis showed that optimal donor and recipient selection and management are predictors for allograft longevity. COF in organs exceeding 100 physiologic years is possible. Extended organ longevity was 5 times more common for livers than kidneys. These analyses support that age alone should not exclude older kidney and liver donors from consideration for transplantation.
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Kaur R, Schick-Makaroff K, Dang P, Sasaki A, Neves P, Mucsi I, Gill J. Navigating Living Kidney Donation and Transplantation Among South Asian Canadians: The ACTION Project. Am J Kidney Dis 2024; 83:750-761.e1. [PMID: 38242424 DOI: 10.1053/j.ajkd.2023.11.009] [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: 05/30/2023] [Revised: 11/02/2023] [Accepted: 11/14/2023] [Indexed: 01/21/2024]
Abstract
RATIONALE & OBJECTIVE South Asian (SA) Canadians with kidney failure have a 50%-77% lower likelihood of kidney transplant and are less likely to identify potential living donors (LDs). This study aimed to identify health system-, patient-, and community-level barriers and facilitators for accessing LD kidney transplantation in the SA community to inform the development of health system- and community-level interventions to address barriers. STUDY DESIGN Qualitative study. SETTING & PARTICIPANTS 20 SA recipients of an LD or deceased-donor kidney transplant, 10 SA LDs, and 41 general SA community members. ANALYTICAL APPROACH In-depth multilingual interviews were conducted with recipients and LDs. Gender-, language-, and age-stratified focus groups were conducted with general SA community members. Summative content analysis was used to analyze the data. RESULTS Hesitancy in approaching potential donors, fear about the health of potential LDs, information gaps, language barriers, and challenges evaluating out-of-country donors were highlighted as significant barriers by recipients, and financial concerns and information gaps were identified by donors. Cultural barriers in the SA community were highlighted by donors, recipients, and community members as critical factors when considering donation and transplant; women and elderly SA Canadians highlighted nuanced challenges. Participants reported generally a favorable perception of their health care teams, citing SA representation in the teams as important to providing culturally and linguistically sensitive care. LIMITATIONS Limited geographic, race, and cultural representation and reliance on virtual data collection. CONCLUSIONS This study highlights several culturally relevant barriers to donation and transplant that are potentially modifiable through patient-, health system-, and community-focused engagement and education.
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Affiliation(s)
- Reetinder Kaur
- Providence Health Care Research Institute, Vancouver, BC, Canada
| | | | - Phuc Dang
- Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Ayumi Sasaki
- Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Paula Neves
- Centre for Living Organ Donation, University Health Network, Toronto, ON, Canada
| | - Istvan Mucsi
- Ajmera Transplant Center, University Health Network, Toronto, ON, Canada; Division of Nephrology, University of Toronto, Toronto, ON, Canada
| | - Jagbir Gill
- Division of Nephrology, Department of Medicine, and Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, BC, Canada.
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Betjes MGH, Kho MML, Roodnat J, de Weerd AE. Transplant Candidates of 70+ Years Have Superior Survival If Receiving Pre-Emptively a Living Donor Kidney. J Clin Med 2024; 13:1853. [PMID: 38610618 PMCID: PMC11012907 DOI: 10.3390/jcm13071853] [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: 02/19/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The number of kidney transplant recipients over 70 years of age is increasing but detailed data on patient and graft survival in the modern era of immune suppression are few. Methods: A single-center cohort of patients of 70 years and older (n = 349) at time of kidney transplantation from 2010-2020 were followed until January 2023. Results: The median age was 73 years with a median follow-up of 4.3 years. Fifty percent of recipients of a living donor kidney (LDK, n = 143) received their graft pre-emptively. Cumulative death-censored graft survival was excellent in the LDK group and reached 98% at 5 years vs. 85% in the deceased donor kidney (DDK) group. Primary non-function (38%) and rejection (43%) were the major causes of graft loss in the first year after DDK transplantation. Rejection-related graft loss was 4.6% during follow-up. Median recipient survival was superior in the subgroup of pre-emptively transplanted LDK patients compared to non-pre-emptively LDK transplanted patients (11.1 versus 6.2 years). Non-pre-emptively transplanted patients had a significantly increased incidence of infection (HR 3.81, 1.46-9.96) and cardiovascular-related causes of death (HR 3.35, 1.16-9.71). Pre-emptive transplantation was also associated with a significantly improved graft survival in the DDK recipients but this result was confounded by significantly better HLA matching and younger donor age in this group. Conclusions: Pre-emptive LDK transplantation in patients of 70 years or older confers superior graft and recipient survival.
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Affiliation(s)
- Michiel G. H. Betjes
- Rotterdam Transplantation Institute, Department of Nephrology & Transplantation, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands; (M.M.L.K.); (J.R.); (A.E.d.W.)
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7
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Weightman AC, Coghlan S, Clayton PA. Respecting living kidney donor autonomy: an argument for liberalising living kidney donor acceptance criteria. Monash Bioeth Rev 2023; 41:156-173. [PMID: 36484936 PMCID: PMC10654180 DOI: 10.1007/s40592-022-00166-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Abstract
Doctors routinely refuse donation offers from prospective living kidney donors with certain comorbidities such as diabetes or obesity out of concern for donor wellbeing. This refusal occurs despite the ongoing shortage of kidney transplants and the superior performance of living donor kidney transplants compared to those from deceased donors. In this paper, we argue that this paternalistic refusal by doctors is unjustified and that, within limits, there should be greater acceptance of such donations. We begin by describing possible weak and strong paternalistic justifications of current conservative donor acceptance guidelines and practices. We then justify our position by outlining the frequently under-recognised benefits and the routinely overestimated harms of such donation, before discussing the need to respect the autonomy of willing donors with certain comorbidities. Finally, we respond to a number of possible objections to our proposal for more liberal kidney donor acceptance criteria. We use the situation in Australia as our case study, but our argument is applicable to comparable situations around the world.
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Affiliation(s)
- Alison C Weightman
- Adelaide Medical School, University of Adelaide, Adelaide, Australia.
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, 5000, Australia.
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, 5000, Australia.
| | - Simon Coghlan
- Centre for AI and Digital Ethics, School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Philip A Clayton
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, 5000, Australia
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, 5000, Australia
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8
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Visan SR, Baruch R, Schwartz D, Schwartz IF, Goykhman Y, Raz MA, Shashar M, Cohen-Hagai K, Nacasch N, Kliuk-Ben-Bassat O, Grupper A. The Long-Term Outcome of Kidney Transplant Recipients in the Eighth Decade Compared With Recipients in the Seventh Decade of Life. Transplant Proc 2023; 55:2063-2070. [PMID: 37748966 DOI: 10.1016/j.transproceed.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/05/2023] [Accepted: 08/01/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND With the aging of the population, more older patients are being considered for kidney transplantation; therefore, it is crucial to evaluate the risks and benefits of transplantation in this population. This study aimed to assess long-term outcomes of kidney transplantation in a cohort of patients who underwent kidney transplantation at age >70 years, compared with patients aged 60 to 69 years at transplantation. METHODS Included in the study were 261 consecutive kidney transplant recipients: 52 were aged >70 years, and 209 were aged 60 to 69 years at transplantation. Data were collected retrospectively and analyzed using multivariate logistic regression to identify potential outcome risk factors. RESULTS The number of transplants in both groups increased during the study period. Mortality after transplantation was strongly correlated to age (hazard ratio [HR] = 1.11; 95% CI, 1.05-1.18; P < .001), deceased donor (HR = 2.0; 95% CI, 1.1-3.8; P = .034), and pretransplant diabetes (HR = 2.9; 95% CI, 1.7-4.9; P = .001). Recipients aged >70 years had an increased risk of death censored graft failure (HR = 2.98; 95% CI, 1.56-5.74; P = .001). In living donor transplants, 3-year survival was 80% in recipients age >70 years, compared with 98% in the 60- to 69-year group. Five-year survival was 71% and 92%, respectively. In deceased donor transplants, 3-year survival was 63% and 78%, and 5-year survival was 58% and 72%, respectively. The risk of malignancy (excluding nonmelanotic skin cancer) was nearly triple in the age >70 years group (HR = 2.96; 95% CI, 1.3-6.8; P = .01). CONCLUSIONS Patient and graft survival in kidney recipients in the eighth decade is worse compared with recipients in the seventh decade of life. However, it is improved with living kidney donation.
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Affiliation(s)
- Shirley Rahel Visan
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Roni Baruch
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel; Organ Transplantation Unit, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Doron Schwartz
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Idit F Schwartz
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yaacov Goykhman
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Organ Transplantation Unit, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Michal Ariela Raz
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel; Organ Transplantation Unit, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Moshe Shashar
- Nephrology Section, Laniado Hospital, Netanya, Israel
| | - Keren Cohen-Hagai
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Naomi Nacasch
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Orit Kliuk-Ben-Bassat
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ayelet Grupper
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel; Organ Transplantation Unit, Tel-Aviv Medical Center, Tel Aviv, Israel.
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Almeida M, Ribeiro C, Silvano J, Pedroso S, Tafulo S, Martins LS, Ramos M, Malheiro J. Living Donors' Age Modifies the Impact of Pre-Donation Estimated Glomerular Filtration Rate on Graft Survival. J Clin Med 2023; 12:6777. [PMID: 37959241 PMCID: PMC10649187 DOI: 10.3390/jcm12216777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The global scarcity of organs for kidney transplants (KTs) has led to the increased acceptance of living donors (LDs) with minor abnormalities to increase the donor pool.. We sought to evaluate the effects of some of these LDs' clinical characteristics (older age, borderline renal function, hypertension, dyslipidemia, smoking, and obesity) on graft outcomes. METHODS We studied 352 recipients of LDKTs (1998-2020). Firstly, considering the recipients and KT variables, we identified relevant predictors of overall and censored graft failure (GF). Then, adjusting for these predictors, we explored LD variables as predictors of overall and censored GF in a multivariable Cox model. RESULTS The recipients from LD with higher eGFR (≥90 mL/min/1.73 m2) had significantly better overall and censored graft survival GS) at 15 y after KT (respectively, 67 and 75% vs. 46 and 46%, p < 0.001). Importantly, none of the remaining LD factors which were evaluated (hypertension, dyslipidemia, smoking, proteinuria, and obesity) were independent predictors of GF. In recipients from LDs < 50 y, having an eGFR < 90 was an independent predictor of overall GF [adjusted HR (95%CI) of 2.578 (1.120-5.795)] and censored GF [adjusted HR (95%CI) of 3.216 (1.300-7.959)], compared to recipients from LDs with eGFR ≥ 90. Contrarily, when donors were older, no difference in the risk of GF was observed between eGFR categories. CONCLUSION In our cohort, lower pre-donation eGFR had an impact on GS only in younger LDs. An age-adjusted eGFR cutoff may be pursued for improved donor admissibility.
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Affiliation(s)
- Manuela Almeida
- Department of Nephrology, Centro Hospitalar Universitário de Santo António (CHUdSA), 4099-001 Porto, Portugal; (C.R.); (J.S.); (S.P.); (L.S.M.); (J.M.)
- UMIB—Unit for Multidisciplinary Research in Biomedicine, ICBAS—School of Medicine and Biomedical Sciences, University of Porto, 4050-348 Porto, Portugal;
| | - Catarina Ribeiro
- Department of Nephrology, Centro Hospitalar Universitário de Santo António (CHUdSA), 4099-001 Porto, Portugal; (C.R.); (J.S.); (S.P.); (L.S.M.); (J.M.)
| | - José Silvano
- Department of Nephrology, Centro Hospitalar Universitário de Santo António (CHUdSA), 4099-001 Porto, Portugal; (C.R.); (J.S.); (S.P.); (L.S.M.); (J.M.)
| | - Sofia Pedroso
- Department of Nephrology, Centro Hospitalar Universitário de Santo António (CHUdSA), 4099-001 Porto, Portugal; (C.R.); (J.S.); (S.P.); (L.S.M.); (J.M.)
- UMIB—Unit for Multidisciplinary Research in Biomedicine, ICBAS—School of Medicine and Biomedical Sciences, University of Porto, 4050-348 Porto, Portugal;
| | - Sandra Tafulo
- UMIB—Unit for Multidisciplinary Research in Biomedicine, ICBAS—School of Medicine and Biomedical Sciences, University of Porto, 4050-348 Porto, Portugal;
- Instituto Português do Sangue e da Transplantação, 4200-139 Porto, Portugal
| | - La Salete Martins
- Department of Nephrology, Centro Hospitalar Universitário de Santo António (CHUdSA), 4099-001 Porto, Portugal; (C.R.); (J.S.); (S.P.); (L.S.M.); (J.M.)
- UMIB—Unit for Multidisciplinary Research in Biomedicine, ICBAS—School of Medicine and Biomedical Sciences, University of Porto, 4050-348 Porto, Portugal;
| | - Miguel Ramos
- Department of Urology, Centro Hospitalar Universitário de Santo António (CHUdSA), 4099-001 Porto, Portugal;
| | - Jorge Malheiro
- Department of Nephrology, Centro Hospitalar Universitário de Santo António (CHUdSA), 4099-001 Porto, Portugal; (C.R.); (J.S.); (S.P.); (L.S.M.); (J.M.)
- UMIB—Unit for Multidisciplinary Research in Biomedicine, ICBAS—School of Medicine and Biomedical Sciences, University of Porto, 4050-348 Porto, Portugal;
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10
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Betjes MGH, De Weerd A. Lowering maintenance immune suppression in elderly kidney transplant recipients; connecting the immunological and clinical dots. Front Med (Lausanne) 2023; 10:1215167. [PMID: 37502354 PMCID: PMC10368955 DOI: 10.3389/fmed.2023.1215167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/09/2023] [Indexed: 07/29/2023] Open
Abstract
The management of long-term immune suppressive medication in kidney transplant recipients is a poorly explored field in the area of transplant medicine. In particular, older recipients are at an increased risk for side effects and have an exponentially increased risk of infection-related death. In contrast, an aged immune system decreases the risk of acute T-cell-mediated rejection in older recipients. Recent advances in alloimmunity research have shown a rapid and substantial decline in polyfunctional, high-risk CD4+ T cells post-transplantation. This lowers the direct alloreactivity responsible for T-cell-mediated rejection, also known as donor-specific hyporesponsiveness. Chronic antibody-mediated rejection (c-aABMR) is the most frequent cause of kidney graft loss in the long term. However, in older adults, c-aABMR as a cause of graft loss is outnumbered by death with a functioning graft. In addition, DSA development and a diagnosis of c-aABMR plateau ~10 years after transplantation, resulting in a very low risk for rejection thereafter. The intensity of immune suppression regimes could likely be reduced accordingly, but trials in this area are scarce. Tacrolimus monotherapy for 1 year after transplantation seems feasible in older kidney transplant recipients with standard immunological risk, showing the expected benefits of fewer infections and better vaccination responses.
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11
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Ribeiro LC, Almeida M, Malheiro J, Silva F, Nunes-Carneiro D, Martins LS, Pedroso S, Silva-Ramos M. Association of the Calcification Score of the Abdominal Aorta, Common Iliac, and Renal Arteries with Outcomes in Living Kidney Donors. J Clin Med 2023; 12:jcm12093339. [PMID: 37176779 PMCID: PMC10179313 DOI: 10.3390/jcm12093339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Vascular calcification is an ever-more-common finding in protocoled pre-transplant imaging in living kidney donors. We intended to explore whether a connection could be found between the Agatston calcification score, prior to kidney donation, and post-donation renal function. METHODS This is a retrospective analysis of 156 living kidney donors who underwent living donor nephrectomy between January 2010 and December 2016. We quantified the total calcification score (TCaScore) by calculating the Agatston score for each vessel, abdominal aorta, common iliac, and renal arteries. Donors were placed into two different groups based on their TCaScore: <100 TCaScore group and ≥100 TCaScore group. The relationship between TCaScore, 1-year eGFR, proteinuria, and risk of 1 measurement of decreased renal function (eGFR < 60 mL/min/1.73 m2) over 5 years of follow-up was investigated. RESULTS The ≥100 TCaScore group consisted of 29 (19%) donors, with a median (interquartile range) calcification score of 164 (117-358). This group was significantly older, 56.7 ± 6.9 vs. 45.5 ± 10.6 (p < 0.001), had a higher average BMI (p < 0.019), and had a lower preoperative eGFR (p < 0.014). The 1-year eGFR was similarly diminished, 69.9 ± 15.7 vs. 76.3 ± 15.5 (p < 0.048), while also having an increased risk of decreased renal function during the follow-up, 22% vs. 48% (p < 0.007). CONCLUSIONS Our study, through univariate analyses, found a relationship between a TCaScore > 100, lower 1-year eGFR, and decreased renal function in 5 years. However, a higher-than-expected vascular calcification should not be an excluding factor in donors, although they may require closer monitoring during follow-up.
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Affiliation(s)
- Luís Costa Ribeiro
- School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal
| | - Manuela Almeida
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, 4050-366 Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal
| | - Jorge Malheiro
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, 4050-366 Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal
| | - Filipa Silva
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, 4050-366 Porto, Portugal
| | - Diogo Nunes-Carneiro
- Urology Department, Centro Hospitalar e Universitário do Porto, 4050-366 Porto, Portugal
| | - La Salete Martins
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, 4050-366 Porto, Portugal
| | - Sofia Pedroso
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, 4050-366 Porto, Portugal
| | - Miguel Silva-Ramos
- Urology Department, Centro Hospitalar e Universitário do Porto, 4050-366 Porto, Portugal
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12
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Fleetwood VA, Caliskan Y, Rub FAA, Axelrod D, Lentine KL. Maximizing opportunities for kidney transplantation in older adults. Curr Opin Nephrol Hypertens 2023; 32:204-211. [PMID: 36633323 DOI: 10.1097/mnh.0000000000000871] [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: 01/13/2023]
Abstract
PURPOSE OF REVIEW To summarize the current state of evidence related to the outcomes of older adults who need and receive kidney transplants, and strategies to facilitate appropriate transplant access in this at-risk group. RECENT FINDINGS Older adults are a rapidly growing subgroup of the kidney transplant waitlist. Compared to younger adults, older kidney transplant recipients have increased mortality after kidney transplant and lower death-censored graft survival. In determining suitability for transplantation in older patients, clinicians must balance procedural and immunosuppression-related risk with incremental survival when compared with dialysis. To appropriately increase access to transplantation in this population, clinicians and policy makers consider candidates' chronological age and frailty, as well as the quality of and waiting time for a donated allograft. Given risk of deterioration prior to transplant, candidates should be rapidly evaluated, listed, and transplanted using living donor and or less than ideal deceased donor organs when available. SUMMARY Access to transplantation for older adults can be increased through targeted interventions to address frailty and reduce waiting times through optimized organ use. Focused study and educational interventions for patients and providers are needed to improve the outcomes of this vulnerable group.
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Affiliation(s)
- Vidya A Fleetwood
- Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital
| | - Yasar Caliskan
- Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital
| | - Fadee Abu Al Rub
- Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital
| | | | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital
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13
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Courtney AE, Moorlock G, Van Assche K, Burnapp L, Mamode N, Lennerling A, Dor FJMF. Living Donor Kidney Transplantation in Older Individuals: An Ethical Legal and Psychological Aspects of Transplantation (ELPAT) View. Transpl Int 2023; 36:11139. [PMID: 37152615 PMCID: PMC10161899 DOI: 10.3389/ti.2023.11139] [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: 12/15/2022] [Accepted: 04/12/2023] [Indexed: 05/09/2023]
Abstract
Living donor transplantation is the optimal treatment for suitable patients with end-stage kidney disease. There are particular advantages for older individuals in terms of elective surgery, timely transplantation, and early graft function. Yet, despite the superiority of living donor transplantation especially for this cohort, older patients are significantly less likely to access this treatment modality than younger age groups. However, given the changing population demographic in recent decades, there are increasing numbers of older but otherwise healthy individuals with kidney disease who could benefit from living donor transplantation. The complex reasons for this inequity of access are explored, including conscious and unconscious age-related bias by healthcare professionals, concerns relating to older living donors, ethical anxieties related to younger adults donating to aging patients, unwillingness of potential older recipients to consider living donation, and the relevant legislation. There is a legal and moral duty to consider the inequity of access to living donor transplantation, recognising both the potential disparity between chronological and physiological age in older patients, and benefits of this treatment for individuals as well as society.
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Affiliation(s)
- Aisling E. Courtney
- Regional Nephrology and Transplant Unit, Belfast City Hospital, Belfast, United Kingdom
- *Correspondence: Aisling E. Courtney,
| | - Greg Moorlock
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Kristof Van Assche
- Research Group Personal Rights and Property Rights, University of Antwerp, Antwerp, Belgium
| | - Lisa Burnapp
- NHS Blood and Transplant, Bristol, United Kingdom
| | - Nizam Mamode
- Department of Surgery, King’s College London, London, United Kingdom
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Frank J. M. F. Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
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14
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Older Age is Associated With Lower Utilization of Living Donor Kidney Transplant. Kidney Int Rep 2022; 8:282-293. [PMID: 36815100 PMCID: PMC9939357 DOI: 10.1016/j.ekir.2022.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/09/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Older adults (65 years or older) constitute a substantial and increasing proportion of patients with kidney failure, potentially needing kidney replacement therapy. Living donor kidney transplant (LDKT) offers superior outcomes for suitable patients of all ages. However, exploring LDKT and finding a living donor could be challenging for older adults. Here, we assessed the association between age and utilization of LDKT and assessed effect modification of key variables such as ethnicity and language. Methods This is a retrospective cohort study of patients with kidney failure referred for kidney transplant (KT) assessment in Toronto between January 2006 and December 2013. The association between age and having a potential living donor identified was assessed using logistic regression and the association between age and the receipt of LDKT was assessed using Cox proportional hazards models. Results Of the 1617 participants, 50% were middle-aged (45-64 years old), and 17% were ≥65 years old. In our final multivariable adjusted models, compared to young adults, middle-aged and older adults had lower odds of having a potential living donor identified (odds ratio [OR], 0.47; confidence interval [CI], [0.35-0.63]; OR, 0.30; CI, [0.20-0.43]; P < 0.001, for middle-aged and older adults, respectively), and were less likely to receive LDKT (hazard ratio [HR], 0.79; CI, [0.63-0.99]; P = 0.04; HR, 0.47; CI, [0.30-0.72]; P = 0.001, for middle-aged and older adults, respectively.). Conclusion Age is an independent predictor of receiving LDKT. Considering that nearly 90% of patients with kidney failure in Canada are >45 years of age, these results point to important and potentially modifiable age-related barriers to LDKT.
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15
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Lim JH, Lee GY, Jeon Y, Jung HY, Choi JY, Cho JH, Park SH, Kim YL, Kim HK, Huh S, Yoo ES, Won DI, Kim CD. Elderly kidney transplant recipients have favorable outcomes but increased infection-related mortality. Kidney Res Clin Pract 2022; 41:372-383. [PMID: 35286795 PMCID: PMC9184840 DOI: 10.23876/j.krcp.21.207] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
Background The number of elderly patients with end-stage kidney disease has been increasing, but the outcomes of kidney transplants (KT) remain poorly understood in elderly patients. Therefore, we evaluated the clinical outcomes of elderly KT recipients and analyzed the impact of elderly donors. Methods This retrospective cohort study included patients who underwent KT between 2000 and 2019. KT recipients were divided into four groups according to a combination of recipient and donor age (≥60 or <60 years); elderly recipients: old-to-old (n = 46) and young-to-old (n = 83); young recipients: old-to-young (n = 98) and young-to-young (n = 796). We compared the risks of mortality, graft failure, and acute rejection between groups using Cox regression analysis. Results The incidence of delayed graft function, graft failure, and acute rejection was not different among groups. Annual mean tacrolimus trough level was not lower in elderly recipients than young recipients during 10-year follow-up. Mortality was significantly higher in elderly recipients (p = 0.001), particularly infection-related mortality (p < 0.001). In multivariable Cox regression analysis, old-to-old and young-to-old groups had increased risk of mortality (adjusted hazard ratio [aHR], 2.89; 95% confidence interval [CI], 1.14–7.32; p = 0.03; aHR, 3.06; 95% CI, 1.51–6.20; p = 0.002). However, graft failure and acute rejection risks were not increased in elderly recipients. Conclusion In elderly recipients, graft survival and acute rejection-free survival were not inferior to those of young recipients. However, mortality, especially risk of infection-related death, was increased in elderly recipients. Thus, low immunosuppression intensity might help decrease mortality in elderly recipients.
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Affiliation(s)
- Jeong-Hoon Lim
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ga Young Lee
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yena Jeon
- Department of Statistics, College of Natural Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ji-Young Choi
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sun-Hee Park
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyung-Kee Kim
- Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Huh
- Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Eun Sang Yoo
- Department of Urology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dong-Il Won
- Department of Clinical Pathology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Correspondence: Chan-Duck Kim Division of Nephrology, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Republic of Korea. E-mail:
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16
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Lim WH, Ooi E, Pilmore HL, Johnson DW, McDonald SP, Clayton P, Hawley C, Mulley WR, Francis R, Collins MG, Jaques B, Larkins NG, Davies CE, Wyburn K, Chadban SJ, Wong G. Interactions Between Donor Age and 12-Month Estimated Glomerular Filtration Rate on Allograft and Patient Outcomes After Kidney Transplantation. Transpl Int 2022; 35:10199. [PMID: 35185379 PMCID: PMC8842263 DOI: 10.3389/ti.2022.10199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022]
Abstract
Reduced estimated glomerular filtration rate (eGFR) at 12-months after kidney transplantation is associated with increased risk of allograft loss, but it is uncertain whether donor age and types modify this relationship. Using Australia and New Zealand registry data, multivariable Cox proportional modelling was used to examine the interactive effects between donor age, types and 12-month eGFR on overall allograft loss. We included 11,095 recipients (4,423 received live-donors). Recipients with lowest 12-month eGFR (<30 ml/min/1.73 m2) experienced the greatest risk of allograft loss, with adjusted HR [95% CI) of 2.65 [2.38–2.95] compared to eGFR of 30–60 ml/min/1.73 m2; whereas the adjusted HR for highest eGFR (>60 ml/min/1.73 m2) was 0.67 [0.62–0.74]. The association of 12-month eGFR and allograft loss was modified by donor age (but not donor types) where a higher risk of allograft loss in recipients with lower compared with higher 12-month eGFR being most pronounced in the younger donor age groups (p < 0.01). Recipients with eGFR <30 ml/min/1.73 m2 12-months after transplantation experienced ≥2.5-fold increased risk of overall allograft loss compared to those with eGFR of >60 ml/min/1.73 m2, and the magnitude of the increased risk is most marked among recipients with younger donors. Careful deliberation of other factors including donor age when considering eGFR as a surrogate for clinical endpoints is warranted.
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Affiliation(s)
- Wai H. Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- *Correspondence: Wai H. Lim,
| | - Esther Ooi
- Medical School, University of Western Australia, Perth, WA, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Helen L. Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - David W. Johnson
- Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Stephen P. McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
- Central and Northern Adelaide Renal and Transplantation Services, Adelaide, SA, Australia
- South Australia Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Philip Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
- Central and Northern Adelaide Renal and Transplantation Services, Adelaide, SA, Australia
- South Australia Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Carmel Hawley
- Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - William R. Mulley
- Department of Nephrology, Monash Medical Centre, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Ross Francis
- Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - Michael G. Collins
- School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Bryon Jaques
- Western Australia Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Nicholas G. Larkins
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Nephrology, Perth Children’s Hospital, Perth, WA, Australia
| | - Christopher E. Davies
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
- South Australia Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Kate Wyburn
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Steve J. Chadban
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Germaine Wong
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia
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17
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Yemini R, Rahamimov R, Ghinea R, Mor E. Long-Term Results of Kidney Transplantation in the Elderly: Comparison between Different Donor Settings. J Clin Med 2021; 10:jcm10225308. [PMID: 34830587 PMCID: PMC8618615 DOI: 10.3390/jcm10225308] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/25/2022] Open
Abstract
With scarce organ supply, a selection of suitable elderly candidates for transplant is needed, as well as auditing the long-term outcomes after transplant. We conducted an observational cohort study among our patient cohort >60 years old with a long follow up. (1). Patients and Methods: We used our database to study the results after transplant for 593 patients >60 years old who underwent a transplant between 2000–2017. The outcome was compared between live donor (LD; n = 257) recipients, an old-to-old (OTO, n = 215) group using an extended criteria donor (ECD) kidney, and a young-to-old (YTO, n = 123) group using a standard-criteria donor. The Kaplan−Meir method was used to calculate the patient and graft survival and Cox regression analysis in order to find risk factors associated with death. (2). Results: The 5- and 10-year patient survival was significantly better in the LD group (92.7% and 66.9%) compared with the OTO group (73.3% and 42.8%) and YTO group (70.9% and 40.6%) (p < 0.0001). The 5- and 10-year graft survival rates were 90.3% and 68.5% (LD), 61.7% and 30.9% (OTO), and 64.1% and 39.9%, respectively (YTO group; p < 0.0001 between the LD and the two DD groups). There was no difference in outcome between patients in their 60’s and their 70’s. Factors associated with mortality included: age (HR-1.060), DM (HR-1.773), IHD (HR-1.510), and LD/DD (HR-2.865). (3). Conclusions: Our 17-years of experience seems to justify the rational of an old-to-old allocation policy in the elderly population. Live-donor transplant should be encouraged whenever possible. Each individual decision of elderly candidates for transplant should be based on the patient’s comorbidity and predicted life expectancy.
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Affiliation(s)
- Renana Yemini
- Department of Surgery, Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel;
- Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva 8410501, Israel
| | - Ruth Rahamimov
- Institute of Nephrology, Beilinson Medical Center, Petach-Tikva 49100, Israel;
- Sackler Medical School, Tel-Aviv University, Tel-Aviv 6997801, Israel;
| | - Ronen Ghinea
- Sackler Medical School, Tel-Aviv University, Tel-Aviv 6997801, Israel;
- Transplant Unit, Department of Surgery B, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Eytan Mor
- Institute of Nephrology, Beilinson Medical Center, Petach-Tikva 49100, Israel;
- Sackler Medical School, Tel-Aviv University, Tel-Aviv 6997801, Israel;
- Correspondence:
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18
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A Propensity Score-weighted Comparison of Outcomes Between Living and Standard Criteria Deceased Donor Kidney Transplant Recipients. Transplantation 2021; 104:e317-e327. [PMID: 32496358 DOI: 10.1097/tp.0000000000003337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Consider a theoretical situation in which 2 patients with similar baseline characteristics receive a kidney transplant on the same day: 1 from a standard criteria deceased donor, the other from a living donor. Which kidney transplant will last longer? METHODS We conducted a population-based cohort study using linked administrative healthcare databases from Ontario, Canada, from January 1, 2005, to March 31, 2014, to evaluate several posttransplant outcomes in individuals who received a kidney transplant from a standard criteria deceased donor (n = 1523) or from a living donor (n = 1373). We used PS weighting using overlap weights, a novel weighting method that emphasizes the population of recipients with the most overlap in baseline characteristics. RESULTS Compared with recipients of a living donor, the rate of all-cause graft failure was not statistically higher for recipients of a standard criteria deceased donor (hazard ratio, 1.1; 95% confidence interval [CI], 0.8-1.6). Recipients of a standard criteria deceased donor, compared with recipients of a living donor had a higher rate of delayed graft function (23.6% versus 18.7%; odds ratio, 1.3; 95% CI, 1.0-1.6) and a longer length of stay for the kidney transplant surgery (mean difference, 1.7 d; 95% CI, 0.5-3.0). CONCLUSIONS After accounting for many important donor and recipient factors, we failed to observe a large difference in the risk of all-cause graft failure for recipients of a standard criteria deceased versus living donor. Some estimates were imprecise, which meant we could not rule out the presence of smaller clinically important effects.
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19
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Kim DG, Lee J, Kim MS, Kwon OJ, Jung CW, Lee KW, Yang J, Ahn C, Huh KH. Outcomes of ABO-incompatible kidney transplantation in older patients: a national cohort study. Transpl Int 2020; 34:290-301. [PMID: 33258121 DOI: 10.1111/tri.13794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/17/2020] [Accepted: 11/27/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Outcomes of ABO-incompatible living donor kidney transplantation (ABOi LDKT) in older individuals have not been established. METHODS This multicentric observational study, using data from the Korean Organ Transplantation Registry database, included 634 older patients (≥60 years) undergoing kidney transplantation. We compared clinical outcomes of ABOi LDKT (n = 80) with those of ABO-compatible LDKT (ABOc LDKT, n = 222) and deceased donor kidney transplantation (DDKT, n = 332) in older patients. RESULTS Death-censored graft survival was similar between the three groups (P = 0.141). Patient survival after ABOi LDKT was similar to that after ABOc LDKT (P = 0.489) but higher than that after DDKT (P = 0.038). In multivariable analysis, ABOi LDKT was not risk factor (hazard ratio [HR] 1.73, 95% confidence interval [CI] 0.29-10.38, P = 0.548), while DDKT was significant risk factor (HR 3.49, 95% CI 1.01-12.23, P = 0.049) for patient survival. Although ABOi LDKT showed higher biopsy-proven acute rejection than ABOc LDKT, the difference was not significant after adjustment with covariates. However, ABOi LDKT was significant risk factor for infection (HR 1.66, 95% CI 1.12-2.45, P = 0.012). CONCLUSIONS In older patients, ABOi LDKT was not inferior to ABOc LDKT and was superior to DDKT for patient survival. ABOi LDKT can be recommended for older patients, rather than waiting for DDKT.
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Affiliation(s)
- Deok Gie Kim
- Department of Surgery, Yonsei Wonju University College of Medicine, Wonju, South Korea
| | - Juhan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Oh Jung Kwon
- Department of Surgery, Hanyang University College of Medicine, Seoul, South Korea
| | - Cheol Woong Jung
- Department of Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Kang Wook Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon, South Korea
| | - Jaeseok Yang
- Transplantation Center, Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyu Ha Huh
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
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20
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Renal transplantation in the elderly: Outcomes and recommendations. Transplant Rev (Orlando) 2020; 34:100530. [DOI: 10.1016/j.trre.2020.100530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/09/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022]
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21
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Al Ammary F, Luo X, Muzaale AD, Massie AB, Crews DC, Waldram MM, Qadi MA, Garonzik-Wang J, Henderson ML, Brennan DC, Wiseman AC, Lindrooth RC, Snyder JJ, Coresh J, Segev DL. Risk of ESKD in Older Live Kidney Donors with Hypertension. Clin J Am Soc Nephrol 2019; 14:1048-1055. [PMID: 31239252 PMCID: PMC6625624 DOI: 10.2215/cjn.14031118] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Hypertension in older kidney donor candidates is viewed as safe. However, hypertension guidelines have evolved and long-term outcomes have not been explored. We sought to quantify the 15-year risk of ESKD and mortality in older donors (≥50 years old) with versus those without hypertension. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A United States cohort of 24,533 older donors from 1999 to 2016, including 2265 with predonation hypertension, were linked to Centers for Medicare and Medicaid Services data and the Social Security Death Master File to ascertain ESKD development and mortality. The exposure of interest was predonation hypertension. From 2004 to 2016, hypertension was defined as documented predonation use of antihypertensive therapy, regardless of systolic BP or diastolic BP; from 1999 to 2003, when there was no documentation of antihypertensive therapy, hypertension was defined as predonation systolic BP ≥140 or diastolic BP ≥90 mm Hg. RESULTS Older donors were 82% white, 6% black, 7% Hispanic, and 3% Asian. The median follow-up was 7.1 years (interquartile range, 3.4-11.1; maximum, 18). There were 24 ESKD and 252 death events during the study period. The 15-year risk of ESKD was 0.8% (95% confidence interval [95% CI], 0.4 to 1.6) for donors with hypertension (mean systolic BP, 138 mm Hg) versus 0.2% (95% CI, 0.1 to 0.4) for donors without hypertension (mean systolic BP, 123 mm Hg; adjusted hazard ratio, 3.04; 95% CI, 1.28 to 7.22; P=0.01). When predonation antihypertensive therapy was available, the risk of ESKD was 6.21-fold higher (95% CI, 1.20 to 32.17; P=0.03) for donors using antihypertensive therapy (mean systolic BP, 132 mm Hg) versus those not using antihypertensive therapy (mean systolic BP, 124 mm Hg). There was no significant association between donor hypertension and 15-year mortality (hazard ratio, 1.18; 95% CI, 0.84 to 1.66; P=0.34). CONCLUSIONS Compared with older donors without hypertension, older donors with hypertension had higher risk of ESKD, but not mortality, for 15 years postdonation. However, the absolute risk of ESKD was small.
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Affiliation(s)
| | - Xun Luo
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Allan B. Massie
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | - Madeleine M. Waldram
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | | | - Macey L. Henderson
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alexander C. Wiseman
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard C. Lindrooth
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado
| | - Jon J. Snyder
- Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota; and
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Josef Coresh
- Departments of Medicine and
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Dorry L. Segev
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
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22
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Lemoine M, Titeca Beauport D, Lobbedez T, Choukroun G, Hurault de Ligny B, Hazzan M, Guerrot D, Bertrand D. Risk Factors for Early Graft Failure and Death After Kidney Transplantation in Recipients Older Than 70 Years. Kidney Int Rep 2019; 4:656-666. [PMID: 31080920 PMCID: PMC6506713 DOI: 10.1016/j.ekir.2019.01.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 01/16/2019] [Accepted: 01/21/2019] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Although kidney transplantation carries a survival benefit compared with dialysis, mortality, especially the first year after transplantation, is high in recipients older than 70. The aim of this study was to evaluate early death and graft failure, and to determine the risk factors associated with these events in this specific population. METHODS All patients older than 70 years who received a kidney transplant between January 2000 and December 2014 in the North-West of France were included (n = 171). Baseline characteristics and outcomes after transplantation were studied. Kaplan-Meier analysis was performed to assess patient and graft survival, and Cox regression analysis to evaluate risk factors for graft failure and patient death. RESULTS The mean recipient age was 73.3 ± 2.5 years. Death-censored graft survival at 1, 3, and 5 years were 82.6%, 78.7%, and 75.4%, respectively. Patient survival at 1, 3, and 5 years was 90.1%, 82.5%, and 68.1%, respectively. One year after transplantation, 17 patients (9.9%) were dead, mainly from infectious (58.5%) or cardiovascular disease (29.4%). According to the Cox multivariate analysis, the independent risk factors for death or graft failure during the first year were arrhythmia (odds ratio [OR] 2.26; 95% confidence interval [CI] 1.08-4.8), left-ventricular ejection fraction (LVEF) under 56% (OR 2.38; 95% CI 1.18-4.83), human leucocyte antigen (HLA) antibodies (OR 2.1; 95% CI 1.04-4.2), deceased donor from cardiovascular cause (OR 5.18; 95% CI 1.22-6.3), and acute rejection (OR 2.77; 95% CI 1.2-6.3). CONCLUSION In kidney transplant recipients older than 70 years, cardiac evaluation and immunosuppression optimization seem to be crucial to improve short-term patient and graft survival.
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Affiliation(s)
- Mathilde Lemoine
- Department of Nephrology, Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | | | - Thierry Lobbedez
- Department of Nephrology, Centre Hospitalo-Universitaire de Caen, Caen, France
| | - Gabriel Choukroun
- Department of Nephrology, Centre Hospitalo-Universitaire d’Amiens, Amiens, France
| | | | - Marc Hazzan
- Department of Nephrology, Centre Hospitalo-Universitaire de Lille, Lille, France
| | - Dominique Guerrot
- Department of Nephrology, Centre Hospitalo-Universitaire de Rouen, Rouen, France
- INSERM U1096, Rouen, France
| | - Dominique Bertrand
- Department of Nephrology, Centre Hospitalo-Universitaire de Rouen, Rouen, France
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23
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Schaenman J, Liao D, Phonphok K, Bunnapradist S, Karlamangla A. Predictors of Early and Late Mortality in Older Kidney Transplant Recipients. Transplant Proc 2019; 51:684-691. [PMID: 30979451 DOI: 10.1016/j.transproceed.2019.01.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 01/02/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Older kidney patients with chronic kidney disease benefit significantly from kidney transplantation. However, these older transplant recipients have greater mortality after transplantation than younger transplant recipients. Understanding the impact of comorbidities on post-transplant mortality can improve risk stratification and patient selection. METHODS A single-center analysis of 3105 kidney transplant recipients was performed over a 12-year period. Comorbidities associated with death were evaluated in older and younger transplant recipients. RESULTS The 2 most important factors associated with increased mortality in the first 100 days after transplant were recipient age ≥60 and receipt of deceased donor organs (adjusted odds ratios, 3.29 and 5.80, respectively), with no statistically significant impact of recipient comorbidities. In the later post-transplant period (after the first 100 days), recipient age ≥60 and receipt of deceased donor organs (adjusted hazard ratios [HR] of 2.14 and 2.29, respectively) remained predictors of mortality. We also found that donor age ≥60 and the recipient having cardiovascular disease and diabetes were independent predictors of increased mortality. There was a statistically significant interaction between diabetes and heart disease and recipient age ≥60, with a lesser impact on late mortality in older patients compared to younger patients. CONCLUSIONS This analysis suggests that comorbidities have a larger impact later after transplantation, with less effect on older recipients. These observations suggest that certain comorbid conditions should be evaluated differently in older patients compared to younger ones.
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Affiliation(s)
- J Schaenman
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - D Liao
- Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - K Phonphok
- Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Nephrology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - S Bunnapradist
- Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - A Karlamangla
- Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
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24
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Kidney Transplantation in Elderly Recipients: A Single-Center Experience. Transplant Proc 2019; 51:132-135. [DOI: 10.1016/j.transproceed.2018.04.081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/02/2018] [Accepted: 04/13/2018] [Indexed: 02/02/2023]
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25
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Holscher CM, Ishaque T, Garonzik Wang JM, Haugen CE, DiBrito SR, Jackson K, Muzaale AD, Massie AB, Al Ammary F, Ottman SE, Henderson ML, Segev DL. Living donor postnephrectomy kidney function and recipient graft loss: A dose-response relationship. Am J Transplant 2018; 18:2804-2810. [PMID: 30086198 PMCID: PMC6219620 DOI: 10.1111/ajt.15061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/25/2018] [Accepted: 08/02/2018] [Indexed: 01/25/2023]
Abstract
Development of end-stage renal disease (ESRD) in living kidney donors is associated with increased graft loss in the recipients of their kidneys. Our goal was to investigate if this relationship was reflected at an earlier stage postdonation, possibly early enough for recipient risk prediction based on donor response to nephrectomy. Using national registry data, we studied 29 464 recipients and their donors from 2008-2016 to determine the association between donor 6-month postnephrectomy estimated GFR (eGFR) and recipient death-censored graft failure (DCGF). We explored donor BMI as an effect modifier, given the association between obesity and hyperfiltration. On average, risk of DCGF increased with each 10 mL/min decrement in postdonation eGFR (adjusted hazard ratio [aHR] 1.06, 95% confidence interval [CI] 1.02-1.10, P = .007). The association was attenuated with higher donor BMI (interaction P = .049): recipients from donors with BMI = 20 (aHR 1.12, 95% CI 1.04-1.19, P = .002) and BMI = 25 (aHR 1.07, 95% CI 1.03-1.12, P = .001) had a higher risk of DCGF with each 10 mL/min decrement in postdonation eGFR, whereas recipients from donors with BMI = 30 and BMI = 35 did not have a higher risk. The relationship between postdonation eGFR, donor BMI, and recipient graft loss can inform counseling and management of living donor kidney transplant recipients.
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Affiliation(s)
| | - Tanveen Ishaque
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Christine E. Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sandra R. DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kyle Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shane E. Ottman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.,Scientific Registry of Transplant Recipients, Minneapolis, MN
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26
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Serrano OK, Yadav K, Bangdiwala A, Vock DM, Dunn TB, Finger EB, Pruett TL, Matas AJ, Kandaswamy R. Age alone is not a contraindication to kidney donation: Outcomes of donor nephrectomy in the elderly. Clin Transplant 2018; 32:e13287. [DOI: 10.1111/ctr.13287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Oscar K. Serrano
- Division of Transplantation; Department of Surgery; University of Minnesota; Minneapolis MN USA
| | - Kunal Yadav
- Hume-Lee Transplant Center; Virginia Commonwealth University; Richmond VA USA
| | - Ananta Bangdiwala
- Biostatistics and Bioinformatics Core; Masonic Cancer Center; University of Minnesota; Minneapolis MN USA
| | - David M. Vock
- Division of Biostatistics; School of Public Health; University of Minnesota; Minneapolis MN USA
| | - Ty B. Dunn
- Division of Transplantation; Department of Surgery; University of Minnesota; Minneapolis MN USA
| | - Erik B. Finger
- Division of Transplantation; Department of Surgery; University of Minnesota; Minneapolis MN USA
| | - Timothy L. Pruett
- Division of Transplantation; Department of Surgery; University of Minnesota; Minneapolis MN USA
| | - Arthur J. Matas
- Division of Transplantation; Department of Surgery; University of Minnesota; Minneapolis MN USA
| | - Raja Kandaswamy
- Division of Transplantation; Department of Surgery; University of Minnesota; Minneapolis MN USA
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27
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Arias-Cabrales C, Pérez-Sáez MJ, Redondo-Pachón D, Buxeda A, Burballa C, Bermejo S, Sierra A, Mir M, Burón A, Zapatero A, Crespo M, Pascual J. Usefulness of the KDPI in Spain: A comparison with donor age and definition of standard/expanded criteria donor. Nefrologia 2018; 38:503-513. [PMID: 29884503 DOI: 10.1016/j.nefro.2018.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/01/2018] [Accepted: 03/02/2018] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Kidney donor shortage requires expanding donor selection criteria, as well as use of objective tools to minimize the percentage of discarded organs. Some donor pre-transplant variables such as age, standard/expanded criteria donor (SCD/ECD) definition and calculation of the Kidney Donor Profile Index (KDPI), have demonstrated correlations with patient and graft outcomes. We aimed to establish the accuracy of the three models to determine the prognostic value of kidney transplantation (KT) major outcomes. MATERIAL AND METHODS We performed a retrospective study in deceased donor KTs at our institution. Unadjusted Cox and Kaplan-Meier survival, and multivariate Cox analyses were fitted to analyze the impact of donor age, SCD/ECD and KDPI on outcomes. RESULTS 389 KTs were included. Mean donor age was 53.6±15.2 years; 163 (41.9%) came from ECD; mean KDPI was 69.4±23.4%. Median follow-up was 51.9 months. The unadjusted Cox and Kaplan-Meier showed that the three prognostic variables of interest were related to increased risk of patient death, graft failure and death-censored graft failure. However, in the multivariate analysis only KDPI was related to a higher risk of graft failure (HR 1.03 [95% CI 1.01-1.05]; p=0.014). CONCLUSIONS SCD/ECD classification did not provide significant prognostic information about patient and graft outcomes. KDPI was linearly related to a higher risk of graft failure, providing a better assessment. More studies are needed before using KDPI as a tool to discard or accept kidneys for transplantation.
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Affiliation(s)
- Carlos Arias-Cabrales
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - María José Pérez-Sáez
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Dolores Redondo-Pachón
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Anna Buxeda
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Carla Burballa
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Sheila Bermejo
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Adriana Sierra
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Marisa Mir
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Andrea Burón
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain; REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain
| | - Ana Zapatero
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Marta Crespo
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Julio Pascual
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain.
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28
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[Focusing on kidney transplantation in the elderly]. Nephrol Ther 2017; 14:71-80. [PMID: 29173815 DOI: 10.1016/j.nephro.2017.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/14/2017] [Accepted: 06/25/2017] [Indexed: 02/06/2023]
Abstract
Due to the increase in life expectancy and the ageing of end-stage renal disease patients, the number of patients older than 65 years receiving a kidney transplant has been continuously growing over the last fifteen years. The benefits of renal transplantation compared to dialysis in terms of survival and quality of life have been shown in selected recipients over 65, or 70 years. However, the age remains the main limiting factor for the access to the waiting list, and the reluctance of the clinicians can be explained by the multiple comorbidities of these candidates, their limited life expectancy or the shortage of grafts. The challenge is to select the candidates who can benefit from renal transplantation, thanks to rigorous cardiovascular and neoplastic evaluation before enrolment and by taking into account the specific characteristics of elderly patients. The living donor appears to be the ideal option for elderly recipients, the alternative being the extended criteria donor, allowing waiting times to be limited. The choice of immunosuppressive therapy is also crucial in these patients at high risk of infectious and cardiovascular complications in whom the occurrence of acute rejection can have severe consequences. There are currently no specific recommendations for immunosuppression in elderly recipients, and we would need large-scale randomized studies to improve the prognosis of renal transplantation in this population.
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29
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Neri F, Furian L, Cavallin F, Ravaioli M, Silvestre C, Donato P, La Manna G, Pinna AD, Rigotti P. How does age affect the outcome of kidney transplantation in elderly recipients? Clin Transplant 2017. [DOI: 10.1111/ctr.13036/?url=http://interact.sh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Flavia Neri
- Kidney and Pancreas Transplant Unit Department of Surgery, Oncology and Gastroenterology Padua University Hospital Padua Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplant Unit Department of Surgery, Oncology and Gastroenterology Padua University Hospital Padua Italy
| | - Francesco Cavallin
- Esophageal and Digestive Tract Surgical Unit Veneto Institute of Oncology IOV IRCCS Padua Italy
| | - Matteo Ravaioli
- General Surgery and Transplant Unit Department of Medical and Surgical Sciences S. Orsola‐Malpighi Hospital University of Bologna Bologna Italy
| | - Cristina Silvestre
- Kidney and Pancreas Transplant Unit Department of Surgery, Oncology and Gastroenterology Padua University Hospital Padua Italy
| | - Paola Donato
- Kidney and Pancreas Transplant Unit Department of Surgery, Oncology and Gastroenterology Padua University Hospital Padua Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplant Unit S. Orsola‐Malpighi Hospital University of Bologna Bologna Italy
| | - Antonio Daniele Pinna
- General Surgery and Transplant Unit Department of Medical and Surgical Sciences S. Orsola‐Malpighi Hospital University of Bologna Bologna Italy
| | - Paolo Rigotti
- Kidney and Pancreas Transplant Unit Department of Surgery, Oncology and Gastroenterology Padua University Hospital Padua Italy
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30
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Neri F, Furian L, Cavallin F, Ravaioli M, Silvestre C, Donato P, La Manna G, Pinna AD, Rigotti P. How does age affect the outcome of kidney transplantation in elderly recipients? Clin Transplant 2017. [PMID: 28640530 DOI: 10.1111/ctr.13036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aging of the on-dialysis population raises the issue of whether to propose elderly patients for kidney transplantation and how to manage their immunosuppression. This study aimed to analyze the outcome of kidney transplantation on an Italian series of elderly recipients. We included in this retrospective study all patients over 60 years, receiving a deceased-donor kidney transplantation from January 2004 to December 2014 in two north Italian Centers. We analyzed the correlation of recipient age with graft's and patient's survival, delayed graft function, acute cellular rejection (ACR), surgical complications, infections, and glomerular filtration rate. Four hundred and fifty-two patients with a median age of 65 years were included in the study. One-, 3-, and 5-year patient's and graft's survival were, respectively, of 98.7%, 93%, 89% and 94.4%, 87.9%, 81.4%. The increasing recipient age was an independent risk factor only for the patient's (P=.008) and graft's survival (P=.002). ACR and neoplasia were also associated to a worse graft survival. The reduced graft survival in elderly kidney recipients seems to be related more to the increasing recipient's age than to the donor's features. In this population, the optimization of organ allocation and immunosuppression may be the key factors to endorse improvements.
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Affiliation(s)
- Flavia Neri
- Kidney and Pancreas Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Francesco Cavallin
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
| | - Matteo Ravaioli
- General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cristina Silvestre
- Kidney and Pancreas Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Paola Donato
- Kidney and Pancreas Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Daniele Pinna
- General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Rigotti
- Kidney and Pancreas Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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31
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Gill J, Rose C, Joffres Y, Kadatz M, Gill J. Cold ischemia time up to 16 hours has little impact on living donor kidney transplant outcomes in the era of kidney paired donation. Kidney Int 2017; 92:490-496. [PMID: 28433384 DOI: 10.1016/j.kint.2017.01.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/31/2016] [Accepted: 01/26/2017] [Indexed: 12/12/2022]
Abstract
In living donor transplantation, cold ischemia time is a concern in transplants involving kidney paired donation. The impact of cold ischemia time over eight hours is unknown. Here we examined the association of cold ischemia time with delayed graft function and allograft loss among 48,498 living recipients in the Scientific Registry of Transplant Recipients registry. The incidence of delayed graft function was low but significantly higher among patients with longer cold ischemia times (0-2.0 hours: 3.3%; 2.1-4.0 hours: 3.9%; 4.1-8.0 hours: 4.3%; 8.1-16.0 hours: 5.5%). In multivariate analyses, only those with cold ischemia times of 8.1-16.0 hours had increased odds of delayed graft function (odds ratio 1.47; 95% confidence interval 1.05-2.05) compared to patients with times of 0-2.0 hours. In multivariate time-to-event analyses, cold ischemia times of 16 hours or less were not associated with allograft loss from any cause including death or death-censored graft loss with hazard ratios for cold ischemia times between 8.0-16.0 hours of 0.97 (95% confidence interval 0.74-1.26) and 1.09 (0.81-1.48) compared to patients with times of 0-2.0 hours). The results were consistent in paired and non-kidney paired donation transplants and in those with living donors over 50 years of age. In subgroup analysis restricted to kidney paired donation recipients, there was no difference in the risk of delayed graft function with an odds ratio of 1.40 (0.88, 2.40) or all-cause graft loss with a hazard ratio of 0.89 (0.62, 1.30) in transplant recipients who received kidneys that were shipped versus not shipped. Thus, a cold ischemia time up to 16 hours has limited impact on living donor outcomes. These findings may help expand living donor transplantation through kidney paired donation.
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Affiliation(s)
- Jagbir Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada.
| | - Caren Rose
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Yayuk Joffres
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Kadatz
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Tufts-New England Medical Center, Boston, Massachusetts, USA
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Abstract
PURPOSE OF REVIEW Kidney transplantation from a living kidney donor (LKD) is associated with better long-term survival and quality of life for a patient with end-stage renal disease (ESRD) than dialysis. We reviewed recent literature on the acceptability and outcomes of older adults as LKDs, which may be misunderstood in routine care. RECENT FINDINGS Studies report that receiving a kidney from an older LKD is associated with worse recipient and graft survival compared with receiving a kidney from a younger LKD, but similar recipient and graft survival to receiving a kidney from a standard criteria deceased donor. A kidney from a younger vs. older LKD results in better graft survival in younger recipients, whereas the graft survival is similar in older recipients. Compared with healthy matched nondonors, older LKDs have a similar risk of death and cardiovascular disease and the absolute risk of ESRD after 15 years remains less than 1%. The estimated predonation and postdonation lifetime risk of ESRD varies by age, sex and race with lower incidences in individuals who are older, female and white (vs. African-American). SUMMARY Donor and recipient outcomes from several studies support the acceptability of older adults as LKDs.
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Affiliation(s)
- Ngan N Lam
- aDepartment of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta bDepartment of Medicine, Division of Nephrology, Western University, London, Ontario, Canada
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33
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Concepcion BP, Forbes RC, Schaefer HM. Older candidates for kidney transplantation: Who to refer and what to expect? World J Transplant 2016; 6:650-657. [PMID: 28058214 PMCID: PMC5175222 DOI: 10.5500/wjt.v6.i4.650] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/22/2016] [Accepted: 09/22/2016] [Indexed: 02/05/2023] Open
Abstract
The number of older end-stage renal disease patients being referred for kidney transplantation continues to increase. This rise is occurring alongside the continually increasing prevalence of older end-stage renal disease patients. Although older kidney transplant recipients have decreased patient and graft survival compared to younger patients, transplantation in this patient population is pursued due to the survival advantage that it confers over remaining on the deceased donor waiting list. The upper limit of age and the extent of comorbidity and frailty at which transplantation ceases to be advantageous is not known. Transplant physicians are therefore faced with the challenge of determining who among older patients are appropriate candidates for kidney transplantation. This is usually achieved by means of an organ systems-based medical evaluation with particular focus given to cardiovascular health. More recently, global measures of health such as functional status and frailty are increasingly being recognized as potential tools in risk stratifying kidney transplant candidates. For those candidates who are deemed eligible, living donor transplantation should be pursued. This may mean accepting a kidney from an older living donor. In the absence of any living donor, the choice to accept lesser quality kidneys should be made while taking into account the organ shortage and expected waiting times on the deceased donor list. Appropriate counseling of patients should be a cornerstone in the evaluation process and includes a discussion regarding expected outcomes, expected waiting times in the setting of the new Kidney Allocation System, benefits of living donor transplantation and the acceptance of lesser quality kidneys.
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34
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Nygaard RM, Sirany AM, Wyman EA, Bodner J, Richardson CJ, Ney AL, Odland MD, Hill MJ. A clinical tool to risk stratify potential kidney transplant recipients and predict severe adverse events. Clin Transplant 2016; 30:1494-1500. [DOI: 10.1111/ctr.12848] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Rachel M. Nygaard
- Department of Surgery; Hennepin County Medical Center; Minneapolis MN USA
| | - Anne-Marie Sirany
- Department of Surgery; Hennepin County Medical Center; Minneapolis MN USA
| | - Elizabeth A. Wyman
- Department of Surgery; Hennepin County Medical Center; Minneapolis MN USA
| | - Jennifer Bodner
- Transplant Clinic; Hennepin County Medical Center; Minneapolis MN USA
| | - Chad J. Richardson
- Department of Surgery; Hennepin County Medical Center; Minneapolis MN USA
| | - Arthur L. Ney
- Department of Surgery; Hennepin County Medical Center; Minneapolis MN USA
| | - Mark D. Odland
- Department of Surgery; Hennepin County Medical Center; Minneapolis MN USA
| | - Mark J. Hill
- Department of Surgery; Hennepin County Medical Center; Minneapolis MN USA
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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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36
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Criteria for and Appropriateness of Renal Transplantation in Elderly Patients With End-Stage Renal Disease. Transplantation 2016; 100:e55-65. [DOI: 10.1097/tp.0000000000001367] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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37
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Kurschat C. Nierentransplantation im Alter. Z Gerontol Geriatr 2016; 49:488-93. [DOI: 10.1007/s00391-016-1118-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/06/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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38
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Florit EA, Diekmann F, Budde K, Glander P, Liefeldt L, Nistal J, Oppenheimer F, Campistol JM, Brakemeier S. Living Donor Transplantation: Long-Term Evolution Related to Age Matching. Transplant Proc 2016; 47:2346-50. [PMID: 26518923 DOI: 10.1016/j.transproceed.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The lack of donors is favoring living kidney donor (LKD) transplantation worldwide, quite often beyond the classic age-matching rules. We analysed renal function (RF) at 1 and 5 years in all donor and recipients as well as death-censored graft and patient survival. LKD recipients were divided into 4 subgroups: young recipients-young donors (YR-YD; N = 355), elderly recipients-young donors (ER-YD; N = 13), young recipients-elderly donors (YR-ED; N = 67), and elderly recipients-elderly donors (ER-ED; N = 38). "Elderly" was defined as ≥60 years. RF was better in those who received a young allograft (YR-YD/ER-YD) at any time (P < .001). There was a trend toward higher proteinuria among the recipients of an old allograft (YR-ED/ER-ED) at any time (P = not significant [NS]). However, our population showed low levels of proteinuria and this was not a risk factor for graft failure. Logistic regression model showed that creatinine level at 1 year is a good predictor of graft losses. Graft survival was worse in the allografts from elderly donors (P < .001). Analysing the young recipients, renal survival was inferior in those who received an old kidney (YR-ED; P < .00005) as well as mortality rates at 14 years (P = .03). The RF of young (N = 295) and elderly donors (N = 98) was optimal with no progression to ESRD or deaths registered during follow-up. In conclusion, young recipients of elderly kidneys pay the price of a worse RF, allograft prognosis, and patient prognosis. The pair YR-ED is a doable option, but we recommend age matching when it is possible.
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Affiliation(s)
- E A Florit
- Servicio de Nefrología - Clinical Institute of Nephrology and Urology, Hospital Clinic, Barcelona, Spain
| | - F Diekmann
- Servicio de Nefrología - Clinical Institute of Nephrology and Urology, Hospital Clinic, Barcelona, Spain.
| | - K Budde
- Nephrologie, Charité Campus Mitte, Berlin, Germany
| | - P Glander
- Nephrologie, Charité Campus Mitte, Berlin, Germany
| | - L Liefeldt
- Nephrologie, Charité Campus Mitte, Berlin, Germany
| | - J Nistal
- Servicio de Nefrología - Clinical Institute of Nephrology and Urology, Hospital Clinic, Barcelona, Spain
| | - F Oppenheimer
- Servicio de Nefrología - Clinical Institute of Nephrology and Urology, Hospital Clinic, Barcelona, Spain
| | - J M Campistol
- Servicio de Nefrología - Clinical Institute of Nephrology and Urology, Hospital Clinic, Barcelona, Spain
| | - S Brakemeier
- Nephrologie, Charité Campus Mitte, Berlin, Germany
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39
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Filiopoulos V, Boletis JN. Renal transplantation with expanded criteria donors: Which is the optimal immunosuppression? World J Transplant 2016; 6:103-114. [PMID: 27011908 PMCID: PMC4801786 DOI: 10.5500/wjt.v6.i1.103] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/03/2015] [Accepted: 01/04/2016] [Indexed: 02/05/2023] Open
Abstract
The growing gap between demand and supply for kidney transplants has led to renewed interest in the use of expanded criteria donor (ECD) kidneys in an effort to increase the donor pool. Although most studies of ECD kidney transplantation confirm lower allograft survival rates and, generally, worse outcomes than standard criteria donor kidneys, recipients of ECD kidneys generally have improved survival compared with wait-listed dialysis patients, thus encouraging the pursuit of this type of kidney transplantation. The relative benefits of transplantation using kidneys from ECDs are dependent on patient characteristics and the waiting time on dialysis. Because of the increased risk of poor graft function, calcineurin inhibitor (CNI)-induced nephrotoxicity, increased incidence of infections, cardiovascular risk, and malignancies, elderly recipients of an ECD kidney transplant are a special population that requires a tailored immunosuppressive regimen. Recipients of ECD kidneys often are excluded from transplant trials and, therefore, the optimal induction and maintenance immunosuppressive regimen for them is not known. Approaches are largely center specific and based upon expert opinion. Some data suggest that antithymocyte globulin might be the preferred induction agent for elderly recipients of ECD kidneys. Maintenance regimens that spare CNIs have been advocated, especially for older recipients of ECD kidneys. CNI-free regimens are not universally accepted due to occasionally high rejection rates. However, reduced CNI exposure and CNI-free regimens based on mammalian target of rapamycin inhibitors have shown acceptable outcomes in appropriately selected ECD transplant recipients.
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40
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Querard AH, Foucher Y, Combescure C, Dantan E, Larmet D, Lorent M, Pouteau LM, Giral M, Gillaizeau F. Comparison of survival outcomes between Expanded Criteria Donor and Standard Criteria Donor kidney transplant recipients: a systematic review and meta-analysis. Transpl Int 2016; 29:403-15. [PMID: 26756928 DOI: 10.1111/tri.12736] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/03/2015] [Accepted: 12/16/2015] [Indexed: 12/31/2022]
Abstract
In 2002, the United Network for Organ Sharing proposed increasing the pool of donor kidneys to include Expanded Criteria Donor (ECD). Outside the USA, the ECD definition remains the one used without questioning whether such a graft allocation criterion is valid worldwide. We performed a meta-analysis to quantify the differences between ECD and Standard Criteria Donor (SCD) transplants. We paid particular attention to select studies in which the methodology was appropriate and we took into consideration the geographical area. Thirty-two publications were included. Only five studies, all from the USA, reported confounder-adjusted hazard ratios comparing the survival outcomes between ECD and SCD kidney transplant recipients. These five studies confirmed that ECD recipients seemed to have poorer prognosis. From 29 studies reporting appropriate survival curves, we estimated the 5-year pooled nonadjusted survivals for ECD and SCD recipients. The relative differences between the two groups were lower in Europe than in North America, particularly for death-censored graft failure. It is of primary importance to propose appropriate studies for external validation of the ECD criteria in non-US kidney transplant recipients.
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Affiliation(s)
- Anne-Hélène Querard
- Nephrology, Dialysis, Transplantation, Centre Hospitalier Départemental de Vendée, La Roche sur Yon, France.,EA 4275 SPHERE - bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch, Nantes University, Nantes, France.,Institute for Transplantation, Urology and Nephrology ITUN, CHU Nantes, RTRS 'Centaure', Inserm U1064, Nantes University, Nantes, France
| | - Yohann Foucher
- EA 4275 SPHERE - bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch, Nantes University, Nantes, France.,Institute for Transplantation, Urology and Nephrology ITUN, CHU Nantes, RTRS 'Centaure', Inserm U1064, Nantes University, Nantes, France
| | - Christophe Combescure
- CRC & Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Etienne Dantan
- EA 4275 SPHERE - bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch, Nantes University, Nantes, France
| | - David Larmet
- Institute for Transplantation, Urology and Nephrology ITUN, CHU Nantes, RTRS 'Centaure', Inserm U1064, Nantes University, Nantes, France
| | - Marine Lorent
- EA 4275 SPHERE - bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch, Nantes University, Nantes, France
| | - Lise-Marie Pouteau
- Institute for Transplantation, Urology and Nephrology ITUN, CHU Nantes, RTRS 'Centaure', Inserm U1064, Nantes University, Nantes, France
| | - Magali Giral
- EA 4275 SPHERE - bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch, Nantes University, Nantes, France.,Institute for Transplantation, Urology and Nephrology ITUN, CHU Nantes, RTRS 'Centaure', Inserm U1064, Nantes University, Nantes, France.,LabEx Transplantex Nantes, Centre d'Investigation Clinique Biothérapie, Nantes, France
| | - Florence Gillaizeau
- EA 4275 SPHERE - bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch, Nantes University, Nantes, France.,Institute for Transplantation, Urology and Nephrology ITUN, CHU Nantes, RTRS 'Centaure', Inserm U1064, Nantes University, Nantes, France
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41
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Schiffer L, Krautzig S, Gerbig D, Bintaro P, Haller H, Schiffer M. [Rehabilitation after kidney transplantation: Old problems and new structures]. Internist (Berl) 2015; 57:49-53. [PMID: 26684185 DOI: 10.1007/s00108-015-3808-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Kidney transplantation is currently the best therapeutic option for patients with end stage renal disease. Alternative treatment with hemo- or peritoneal dialysis is associated with higher comorbidities, higher morbidity/mortality, and reduced quality of life. Thus, a major aim in posttransplant care is to develop strategies to increase transplant survival and reduce known risk factors and comorbidities. In this overview, we propose a concept to include rehabilitation clinics in all aspects of the transplant process. This concept includes pretransplant care on the waiting list to prepare the patient for the transplant, the direct postoperative treatment phase, and repeated and risk adapted stays in rehabilitation clinics during long-term follow-up to address specific and individual problems.
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Affiliation(s)
- L Schiffer
- Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - S Krautzig
- PHV-Dialysezentrum Detmold, Detmold, Deutschland.,Kommission Rehabilitation, Transition und Altersmedizin, Deutsche Gesellschaft für Nephrologie, Berlin, Deutschland
| | - D Gerbig
- Kommission Rehabilitation, Transition und Altersmedizin, Deutsche Gesellschaft für Nephrologie, Berlin, Deutschland.,Abteilung Innere Medizin/Nephrologie, Transplantationsnachsorge, Fachklinik Bad Heilbrunn, Bad Heilbrunn, Deutschland
| | - P Bintaro
- Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - H Haller
- Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - M Schiffer
- Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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42
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Kidneys from Older Living Donors Provide Excellent Short and Intermediate Outcomes--A Single China Center's Experience. Transplantation 2015; 99:e81-8. [PMID: 26308304 DOI: 10.1097/tp.0000000000000580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transplantation with kidneys from older living donors is on the rise, yet controversy still exists over whether the outcomes are as satisfactory as with kidneys from younger donors. METHODS We retrospectively analyzed 1009 living donor kidney transplants performed at our center between 2006 and 2013. Graft and patient outcomes were compared between transplants with kidneys from old living donors (OLD, 55-65 years) (n = 264) and from young living donors (YLD, <55 years) (n = 745). RESULTS The age was 32.80 ± 9.71 years and 33.91 ± 5.98 years for recipient in YLD and OLD group, respectively. Death-censored graft survival at 1, 3, and 5 years was 98.8%, 97.1%, and 95.8% in patients receiving YLD kidneys, similar to the corresponding values of 97.6%, 95.5% and 95.5% in patients receiving OLD kidneys (P = 0.356). Patient survival at 1, 3, and 5 years after transplantation was also similar for patients receiving YLD kidneys (98.5%, 97.1%, and 96.7%) and for patients receiving OLD kidneys (99.6%, 99.6%, and 96.8%; P = 0.110). The OLD kidneys were not associated with increased risk of death-censored graft failure (hazard ratio, 2.5; 95% confidence interval, 0.57 to 11.11) and patient death (hazard ratio, 1.67; 95% confidence interval, 0.75 to 3.73). In addition, there is no increased graft loss or patient death for each 10-year increase in donor age. Transplantation with OLD kidneys was not associated with reduced patient or graft outcomes in the short term (≤ 12 months) or medium term (>1 year). CONCLUSIONS Graft and patient outcomes after living-donor kidney transplantation are similar in the short-term and medium-term for donors aged 55 to 65 years and for younger donors. Therefore, the use of OLD kidneys should be encouraged in China.
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43
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Matignon M, Aissat A, Canoui-Poitrine F, Grondin C, Pilon C, Desvaux D, Saadoun D, Barathon Q, Garrido M, Audard V, Rémy P, Lang P, Cohen J, Grimbert P. Th-17 Alloimmune Responses in Renal Allograft Biopsies From Recipients of Kidney Transplants Using Extended Criteria Donors During Acute T Cell-Mediated Rejection. Am J Transplant 2015; 15:2718-25. [PMID: 25989263 DOI: 10.1111/ajt.13304] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/15/2015] [Accepted: 03/07/2015] [Indexed: 01/25/2023]
Abstract
Although renal transplantation using expanded criteria donors has become a common practice, immune responses related to immunosenescence in those kidney allografts have not been studied yet in humans. We performed a retrospective molecular analysis of the T cell immune response in 43 kidney biopsies from patients with acute T cell-mediated rejection including 25 from recipients engrafted with a kidney from expanded criteria donor and 18 from recipients grafted with optimal kidney allograft. The clinical, transplant and acute T cell-mediated rejection characteristics of both groups were similar at baseline. The expression of RORγt, Il-17 and T-bet mRNA was significantly higher in the elderly than in the optimal group (p = 0.02, p = 0.036, and p = 0.01, respectively). Foxp3 mRNA levels were significantly higher in elderly patients experiencing successful acute T cell-mediated rejection reversal (p = 0.03). The presence of IL-17 mRNA was strongly associated with nonsuccessful reversal in elderly patients (p = 0.008). Patients with mRNA IL17 expression detection and low mRNA Foxp3 expression experienced significantly more treatment failure (87.5%) than patients with no mRNA IL17 expression and/or high mRNA Foxp3 expression (26.7%; p = 0.017). Our study suggests that the Th17 pathway is involved in pathogenesis and prognosis of acute T cell-mediated rejection in recipients of expanded criteria allograft.
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Affiliation(s)
- M Matignon
- APHP, Henri Mondor Hospital, Nephrology and Transplantation Department, Créteil, France.,UPEC, Inserm U955, Team 21, Créteil, France.,APHP, Henri Mondor Hospital, CIC biotherapy, Créteil, France
| | - A Aissat
- UPEC, Inserm U955, Team 11, Créteil, France
| | - F Canoui-Poitrine
- APHP, Henri-Mondor hospital, Public Health department and Clinical Research Unit (URC-Mondor), Créteil, France.,UPEC, LIC EA4393, Créteil, France
| | - C Grondin
- UPEC, Inserm U955, Team 21, Créteil, France.,APHP, Henri Mondor Hospital, CIC biotherapy, Créteil, France
| | - C Pilon
- UPEC, Inserm U955, Team 21, Créteil, France.,APHP, Henri Mondor Hospital, CIC biotherapy, Créteil, France
| | - D Desvaux
- UPEC, Inserm U955, Team 21, Créteil, France.,Anatomopathology Department, APHP, Henri Mondor Hospital, Créteil, France
| | - D Saadoun
- APHP, Pitié-Salpêtrière hospital, Internal Medicine and Immunology Department, Centre national de référence des Maladies Autoimmunes et systémiques rares, DHU I2B: Inflammation, Immunopathology, Biotherapy, Paris, France.,Laboratoire I3: Immunology-Immunopathology-Immunotherapeutique, UMR 7211 (UPMC/CNRS), U959 (INSERM), Pierre et Marie Curie University, Paris, France
| | - Q Barathon
- UPEC, Inserm U955, Team 21, Créteil, France.,APHP, Henri Mondor Hospital, CIC biotherapy, Créteil, France
| | - M Garrido
- Laboratoire I3: Immunology-Immunopathology-Immunotherapeutique, UMR 7211 (UPMC/CNRS), U959 (INSERM), Pierre et Marie Curie University, Paris, France
| | - V Audard
- APHP, Henri Mondor Hospital, Nephrology and Transplantation Department, Créteil, France.,UPEC, Inserm U955, Team 21, Créteil, France.,APHP, Henri Mondor Hospital, CIC biotherapy, Créteil, France
| | - P Rémy
- APHP, Henri Mondor Hospital, Nephrology and Transplantation Department, Créteil, France.,UPEC, Inserm U955, Team 21, Créteil, France.,APHP, Henri Mondor Hospital, CIC biotherapy, Créteil, France
| | - P Lang
- APHP, Henri Mondor Hospital, Nephrology and Transplantation Department, Créteil, France.,UPEC, Inserm U955, Team 21, Créteil, France
| | - J Cohen
- UPEC, Inserm U955, Team 21, Créteil, France.,APHP, Henri Mondor Hospital, CIC biotherapy, Créteil, France
| | - P Grimbert
- APHP, Henri Mondor Hospital, Nephrology and Transplantation Department, Créteil, France.,UPEC, Inserm U955, Team 21, Créteil, France.,APHP, Henri Mondor Hospital, CIC biotherapy, Créteil, France
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44
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Dreyer GJ, Hemke AC, Reinders MEJ, de Fijter JW. Transplanting the elderly: Balancing aging with histocompatibility. Transplant Rev (Orlando) 2015; 29:205-11. [PMID: 26411382 DOI: 10.1016/j.trre.2015.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/30/2015] [Accepted: 08/30/2015] [Indexed: 01/10/2023]
Abstract
Across the world, the proportions of senior citizens (i.e. those ≥65years) increase rapidly and are predicted to constitute over 25% of the general population by 2050. In 2012 already 48% of the population with end stage renal disease (ESRD) was aged 65years or older. Transplantation is considered the preferred treatment option for ESRD offering survival advantage over long-term dialysis in the majority of patients. Indeed, acceptable outcomes have been documented for selected patients over the age of 70years or even cases over 80years. The reality of organ scarcity and prolonged waiting times for a deceased donor kidney transplantation, however, indicate that at best 50% of the selected elderly may have realistic expectations to receive a timely transplant offer. By choice or medical selection, access to transplantation also decreases with increasing age. In order to expedite the chance for elderly to receive a kidney transplant dedicated allocation systems have been developed. These allocation systems, like the Eurotransplant Senior Program (ESP), support preferential local allocation of kidneys from older donors to older patients in order to match recipient and graft life while disregarding histocompatibility for HLA antigens. The consequence has been more acute rejection episodes and an increase in immunosuppressive load. In the elderly, the most common cause of graft loss is death with functioning graft and death from infectious diseases is one of the dominant causes. The Eurotransplant Senior DR-compatible Program (ESDP) was designed to further improve the perspective of successful transplantation in the elderly in terms of life and quality of life by re-introducing matching criteria for HLA-DR in the old-for-old algorithm.
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Affiliation(s)
- G J Dreyer
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - A C Hemke
- Nefrovision/Renine, Dutch Transplant Foundation, Leiden, The Netherlands
| | - M E J Reinders
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - J W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
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45
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Abstract
BACKGROUND Previous studies demonstrate that graft survival from older living kidney donors (LD; age>60 years) is worse than younger LD but similar to deceased standard criteria donors (SCD). Limited sample size has precluded more detailed analyses of transplants from older LD. METHODS Using the United Network for Organ Sharing database from 1994 to 2012, recipients were categorized by donor status: SCD, expanded criteria donor (ECD), or LD (by donor age: <60, 60-64, 65-69, ≥70 years). Adjusted models, controlling for donor and recipient risk factors, evaluated graft and recipient survivals. RESULTS Of 250,827 kidney transplants during the study period, 92,646 were LD kidneys, with 4.5% of these recipients (n=4,186) transplanted with older LD kidneys. The use of LD donors 60 years or older increased significantly from 3.6% in 1994 to 7.4% in 2011. Transplant recipients with older LD kidneys had significantly lower graft and overall survival compared to younger LD recipients. Compared to SCD recipients, graft survival was decreased in recipients with LD 70 years or older, but overall survival was similar. Older LD kidney recipients had better graft and overall survival than ECD recipients. CONCLUSIONS As use of older kidney donors increases, overall survival among kidney transplant recipients from older living donors was similar to or better than SCD recipients, better than ECD recipients, but worse than younger LD recipients. With increasing kidney donation from older adults to alleviate profound organ shortages, the use of older kidney donors appears to be an equivalent or beneficial alternative to awaiting deceased donor kidneys.
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Yoo KD, An JN, Kim CT, Cho JH, Kim CD, Park SK, Chae DW, Oh YK, Lim CS, Kim YS, Kim YH, Lee JP. Clinical outcomes in Asian elderly kidney transplant recipients: a multicenter cohort study. Transplant Proc 2015; 47:600-7. [PMID: 25891695 DOI: 10.1016/j.transproceed.2015.01.021] [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] [Received: 12/31/2014] [Accepted: 01/28/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The kidney transplantation rate in elderly patients is increasing rapidly. However, the clinical outcomes of kidney transplantation in elderly patients have not yet been thoroughly evaluated. METHODS This multicenter cohort study included adult kidney transplant recipients (KTRs) admitted to five major tertiary hospitals in Korea between 1997 and 2012. A total of 3,565 adult participants were enrolled. Patient survival, allograft survival, and biopsy-proven acute rejection (BPAR) of 242 elderly recipients (≥ 60 years) were assessed and compared with those of a younger population. RESULTS Patients were divided into five groups according to age at time of transplantation. The proportion of elderly patients was 6.7 % (mean age, 63.1 ± 2.7 years; n = 242). The numbers of male patients (69.4%), those with diabetes mellitus history (36.3%), and those with pretransplantation ischemic heart disease history (17.7%) were significantly higher in the elderly group than in the younger age groups. Elderly patients were more likely to receive a cadaveric kidney, and overall mortality rates were significantly higher in the elderly patients (1-year survival 93.3%, 5-year survival 91.3%). However, death-censored allograft survival rate and BPAR were not affected by patient age (P = .104 and .501, respectively). Among the elderly, BPAR and female donors were independent risk factors for allograft loss. CONCLUSION The overall survival rate of the elderly KTRs was significantly lower than that of younger KTRs. However, the death-censored allograft survival rate did not differ between groups. Kidney transplantation should not be stagnated especially in elderly patients with end-stage renal disease.
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Affiliation(s)
- K D Yoo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - J N An
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - C T Kim
- School of Public Health, Seoul National University, Seoul, Korea
| | - J H Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - C D Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - S K Park
- Department of Internal Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - D W Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Y K Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - C S Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Y S Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Y H Kim
- Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea.
| | - J P Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
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Kim SC, Pearson TC, Tso PL. Revamped Rationing of Renal Resources: Kidney Allocation in Search of Utility and Justice for All. CURRENT TRANSPLANTATION REPORTS 2015. [DOI: 10.1007/s40472-015-0050-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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