The role of various risk factors in living related donor renal transplant success

The Impact of Recipient Demographics on Outcomes from Living Donor Kidneys: Systematic Review and Meta-Analysis

Background and Aims: Recipient demographics affect outcomes after kidney transplantation. The aim of this study was to assess, for kidneys retrieved from living donors, the effect of recipient sex, ethnicity, and body mass index (BMI) on delayed graft function (DGF) and one-year graft function, incidence of acute rejection (AR), and recipient and graft survivals. Methods: A systematic review and meta-analysis was performed. EMBASE and MEDLINE databases were searched using algorithms through Ovid. Web of Science collection, BIOSIS, CABI, Korean Journal database, Russian Science Citation Index, and SciELO were searched through Web of Science. Cochrane database was also searched. Risk of bias was assessed using the NHBLI tools. Data analysis was performed using Revman 5.4. Mean difference (MD) and risk ratio (RR) were used in analysis. Results: A total of 5129 studies were identified; 24 studies met the inclusion criteria and were analysed. Female recipients were found to have a significantly lower serum creatinine 1-year-post renal transplantation (MD: −0.24 mg/dL 95%CI: −0.18 to −0.29 p < 0.01) compared to male recipients. No significant difference in survival between male and female recipients nor between Caucasians and Africans was observed (p = 0.08). However, Caucasian recipients had a higher 1-year graft survival compared to African recipients (95% CI 0.52−0.98) with also a lower incidence of DGF (RR = 0.63 p < 0.01) and AR (RR = 0.55 p < 0.01). Recipient obesity (BMI > 30) was found to have no effect on 1-year recipient (p = 0.28) and graft survival (p = 0.93) compared to non-obese recipients although non-obese recipients had a lower rate of DGF (RR = 0.65 p < 0.01) and AR (RR = 0.81 p < 0.01) compared to obese recipients. Conclusions: Gender mismatch between male recipients and female donors has negative impact on graft survival. African ethnicity and obesity do not to influence recipient and graft survival but negatively affect DGF and AR rates.

Relative impact of donor type on renal allograft survival in black and white recipients

Renal allograft survival of organs from living-related donors (LRDs) is superior to that of organs from cadaveric donors (CAD). Allograft survival rates are lower in black recipients of both CAD and LRD transplants compared with recipients of other races. It is not known whether the superior donor effect of LRD varies between races. We investigated the graft survival outcome of first renal transplants performed in the United States in 1986 and 1989 to determine whether the donor effect differs between black and white recipients. A measurement of "donor type effect" is introduced. There were 7,002 and 7,307 first renal transplants in 1986 and 1989, respectively, for which allograft survival data were available from the United States Renal Data Systems. Both black and white recipients showed a greater than 50% reduction in the risk of allograft loss at all the points studied up to 5 years posttransplant when LRD was chosen over CAD transplantation. A measurement of donor type effect indicates that graft loss is reduced by 7 to 21 percentage points at 1 and 5 years posttransplant. The donor type effect is proportionally equal in both races. Therefore, kidney donation from living relatives as a first transplant should be encouraged for all medically suitable end-stage renal disease patients as a means of improving outcome and reducing CAD transplantation waiting time for patients in whom LRD transplants cannot be performed.

Living related renal transplantation in Ireland: a sixteen year review

Between January 1972 and December 1987, a total of 777 transplants were performed of which 135 (17%) were living related. There were 108 sibling donors, 25 parent to child and 2 child to parent. All sibling transplants were HLA identical. Conventional immunosuppression with Prednisone and Azathioprine was used in all cases. Actuarial patient survival were 95%, 91% and 88% at 1, 5 and 10 years respectively. Corresponding actuarial graft survivals were 90%, 80% and 60%. Graft survival in the sibling compared to the parent to child group was 87% versus 60% at 5 years. There were 13 deaths during the study interval and 32 grafts were lost. Five year patient/graft survivals of 91/80% compare favourably with other reported series. The poorer outcome in parent to child transplants has led us to modify the immunosuppressive protocol to include Cyclosporin A in this group. The increased availability and improved survival of cadaveric grafts in recent years and our one year patient/graft survival of 92/88% has led us to reduce emphasis on living related transplantation in our renal replacement programme.

Transplantation of tissues and organs. Review of the first 100 years of the Southern Surgical Association

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Influence of race of cadaveric kidney donor and recipient on graft survival: a multifactorial analysis

Actuarial survival analysis of 889 cadaver transplant patients between 1972 and 1981 in Michigan reveals functional graft (P = .0003) and patient (P = .004) survivals are improved when donors and recipients are of the same race (black or white). The Cox regression model for multifactorial analysis confirms the significantly lower graft survival for the mixed racial combination group with a relative risk of 1.27 (P less than .05). By this analysis, other significant factors adversely affecting the graft survival rates include diabetes as a cause of end-stage renal disease, earlier date of transplantation, shorter duration of prior dialysis, and a significant center effect. Patient survival has a significantly greater relative risk for the black to white racial combination, diabetes, earlier calendar year of transplantation, and age of patient. While the mixed racial group was slightly older (delta = 2 years), had more hypertension, less glomerulonephritis, and more HLA mismatches, our analysis by the Cox regression model suggests that these factors played only minor roles (P greater than .05) regarding graft survival rates. Therefore, our data suggest that independent of several other factors, cadaver kidneys have a better functional outcome when they are transplanted into recipients of the same race.

High risk factors in transplantation

A standardised system of assessing risk factors for renal transplant outcome and patient survival has been assessed.

The role of the Lewis antigen system in renal transplantation and allograft rejection

The recent literature on the technologic and clinical progress being made in renal transplantation has not emphasized applicable advances in blood group serology. Accumulated data on the Lewis blood group system, however, seem to implicate Lewis incompatibilities between kidney donors and recipients as contributing factors in allograft rejection. Lewis antigens may be capable of inciting both cell-mediated and humoral immune responses of a cytotoxic nature, and such antigens are expressed on cell surfaces of the renal parenchyma in Lewis-positive persons. Hence, this serologically defined system could be the source of diminished allograft survival in recipients who are mismatched with their organ donors for Lewis antigens, despite compatibility within other histocompatibility antigen systems. This premise is still open to question, and future, controlled, clinical studies will be necessary to establish a definite role for the Lewis antigen system in renal transplant rejection.