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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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Stephan A. The Limited Value of the Extended Criteria Donor. EXP CLIN TRANSPLANT 2022; 20:10-12. [DOI: 10.6002/ect.donorsymp.2022.l6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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3
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Burghelea D, Moisoiu T, Ivan C, Elec A, Munteanu A, Iancu ȘD, Truta A, Kacso TP, Antal O, Socaciu C, Elec FI, Kacso IM. The Use of Machine Learning Algorithms and the Mass Spectrometry Lipidomic Profile of Serum for the Evaluation of Tacrolimus Exposure and Toxicity in Kidney Transplant Recipients. Biomedicines 2022; 10:biomedicines10051157. [PMID: 35625894 PMCID: PMC9138871 DOI: 10.3390/biomedicines10051157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 12/10/2022] Open
Abstract
Tacrolimus has a narrow therapeutic window; a whole-blood trough target concentration of between 5 and 8 ng/mL is considered a safe level for stable kidney transplant recipients. Tacrolimus serum levels must be closely monitored to obtain a balance between maximizing efficacy and minimizing dose-related toxic effects. Currently, there is no specific tacrolimus toxicity biomarker except a graft biopsy. Our study aimed to identify specific serum metabolites correlated with tacrolinemia levels using serum high-precision liquid chromatography–mass spectrometry and standard laboratory evaluation. Three machine learning algorithms were used (Naïve Bayes, logistic regression, and Random Forest) in 19 patients with high tacrolinemia (8 ng/mL) and 23 patients with low tacrolinemia (5 ng/mL). Using a selected panel of five lipid metabolites (phosphatidylserine, phosphatidylglycerol, phosphatidylethanolamine, arachidyl palmitoleate, and ceramide), Mg2+, and uric acid, all three machine learning algorithms yielded excellent classification accuracies between the two groups. The highest classification accuracy was obtained by Naïve Bayes, with an area under the curve of 0.799 and a classification accuracy of 0.756. Our results show that using our identified five lipid metabolites combined with Mg2+ and uric acid serum levels may provide a novel tool for diagnosing tacrolimus toxicity in kidney transplant recipients. Further validation with targeted MS and biopsy-proven TAC toxicity is needed.
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Affiliation(s)
- Dan Burghelea
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (D.B.); (T.M.); (A.E.); (A.M.); (O.A.)
- Department of Urology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Tudor Moisoiu
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (D.B.); (T.M.); (A.E.); (A.M.); (O.A.)
- Department of Urology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Biomed Data Analytics SRL, 400696 Cluj-Napoca, Romania
| | - Cristina Ivan
- “Regina Maria” Hospital, 400117 Cluj-Napoca, Romania;
| | - Alina Elec
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (D.B.); (T.M.); (A.E.); (A.M.); (O.A.)
| | - Adriana Munteanu
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (D.B.); (T.M.); (A.E.); (A.M.); (O.A.)
| | - Ștefania D. Iancu
- Faculty of Physics, Babeș-Bolyai University, 400084 Cluj-Napoca, Romania;
| | - Anamaria Truta
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400337 Cluj-Napoca, Romania;
| | - Teodor Paul Kacso
- Department of Nephrology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania; (T.P.K.); (I.M.K.)
| | - Oana Antal
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (D.B.); (T.M.); (A.E.); (A.M.); (O.A.)
- Department of Anesthesiology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Carmen Socaciu
- Faculty of Food Science and Technology, University of Agricultural Science and Veterinary Medicine Cluj-Napoca, Calea Mănăştur 3–5, 400372 Cluj-Napoca, Romania;
| | - Florin Ioan Elec
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (D.B.); (T.M.); (A.E.); (A.M.); (O.A.)
- Department of Urology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-756285972
| | - Ina Maria Kacso
- Department of Nephrology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania; (T.P.K.); (I.M.K.)
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Impact of the explanting surgeon's impression of donor arteriosclerosis on outcome of kidney transplantations from donors aged ≥65 years. Langenbecks Arch Surg 2021; 407:727-737. [PMID: 34825954 DOI: 10.1007/s00423-021-02383-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Careful donor selection is important for kidney transplantations (KT) from suboptimal donors aged ≥65 years. Several tools such as histopathological assessment of preimplant biopsies have been shown to predict allograft survival and can be applied for selection. Whether the explanting surgeon's appraisal is associated with outcomes of KTs from suboptimal donors is unknown. METHODS We compared outcomes of KTs from ≥65-year-old deceased donors performed at our centre between 1999 and 2018 for which grading of macroscopic 'donor arteriosclerosis' (n=104) and 'organ quality' (n=208) as judged by the explanting surgeon and documented on the Eurotransplant kidney organ report was available. RESULTS No association was observed between degree of macroscopic donor arteriosclerosis and death-censored graft survival in univariable or multivariable regression analyses. Compared to KTs from donors with no/mild arteriosclerosis, KTs from donors with moderate/severe arteriosclerosis were associated with a significantly impaired allograft function 3 months, 1 year and 3 years after transplantation (e.g. at 3 years: 176.8 µmol/l vs 137.0 µmol/l, P=0.003). Following multivariable regression analysis, these differences remained significant at 3 months and 3 years after KT. No association was observed between degree of macroscopic arteriosclerosis and mortality or primary non-function as well as no consistent association with delayed graft function and histological arteriosclerosis. Assessment of 'organ quality' was not associated with outcomes. CONCLUSION Our data suggest that the explanting surgeon's assessment of donor arteriosclerosis is associated with allograft function. Larger studies and better standardization of kidney inspection after explantation are required to further explore the impact of surgeon's appraisal in KT.
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Tegzess E, Gomes Neto AW, Pol RA, de Boer SE, Peters-Sengers H, Sanders JSF, Berger SP. Comparative survival of elderly renal transplant recipients with a living donor versus a deceased donor: A retrospective single center observational study. Transpl Int 2021; 34:2746-2754. [PMID: 34626451 PMCID: PMC9297933 DOI: 10.1111/tri.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
Increasing numbers of elderly (≥65 years) patients are listed for kidney transplantation. This study compares the survival outcome between living (LDK), regularly allocated (ETKAS), and Eurotransplant Senior Program (ESP) donor kidneys in elderly recipients. This is a single-center retrospective cohort study of elderly kidney transplant recipients transplanted between 2005 and 2017. Primary outcome measures were nondeath-censored graft, death-censored graft, and patient survival. In total, 348 patients were transplanted, 109 recipients (31.3%) received an LDK, 100 (28.7%) an ETKAS, and 139 (40%) an ESP kidney. 62.5% were male, and median age was 68 years. LDK recipients had significantly better 5-year nondeath-censored graft survival compared with ETKAS and ESP (resp. 71.0% vs. 66.1% vs. 55.6%, P = 0.047). Death-censored graft survival after 1 year was significantly better in LDK recipients (99.1%) (ETKAS 90.8%; ESP 87.7%, P < 0.001). After 5 years, the difference remained significant (P < 0.001) with little additional graft loss (97.7% vs. 88.1% vs. 85.6). There was no significant difference in patient survival after 5 years (71.7% vs. 67.4% vs 61.9%, P = 0.480). In elderly recipients, the patient survival benefits of an LDK are limited, but there is decreased death-censored graft loss for LDK recipients. Nevertheless, graft survival in ETKAS and ESP remains satisfactory.
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Affiliation(s)
- Erzsi Tegzess
- Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Antonio W Gomes Neto
- Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Silke E de Boer
- Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Hessel Peters-Sengers
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan-Stephan F Sanders
- Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Stefan P Berger
- Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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6
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Schachtner T, Otto NM, Reinke P. Two decades of the Eurotransplant Senior Program: the gender gap in mortality impacts patient survival after kidney transplantation. Clin Kidney J 2020; 13:1091-1100. [PMID: 33391754 PMCID: PMC7769544 DOI: 10.1093/ckj/sfz118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/09/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Long-term outcomes of the Eurotransplant Senior Program (ESP) are urgently needed to improve selection criteria and allocation policies in the elderly. METHODS We analysed patient and allograft outcomes of 244 ESP-kidney transplant recipients (KTRs) between 1999 and 2019 and assessed quality of living compared with 82 ESP-waitlisted dialysis patients using standardized short form-8. RESULTS We observed 1-, 5- and 10-year patient survival of 91.7, 66.3 and 38.0%, respectively. Mortality risk factors included male gender (P = 0.006) and T-cell-mediated rejection (P < 0.001). Median patient survival of male ESP-KTRs was 80 versus 131 months for female ESP-KTRs (P = 0.006). 1-, 5- and 10-year death-censored allograft survival was 93.3, 82.6 and 70.4%. Risk factors included high body mass index (P < 0.001) and T-cell-mediated rejection (P < 0.001). After re-initiation of dialysis median patient survival was 58 months. Change of estimated glomerular filtration rate showed a mean decline of 2.3 and 6.8 mL/min at 5 and 10 years. Median physical and mental component scores of ESP-KTRs were 40.2 and 48.3, significantly higher compared with dialysis patients (P < 0.05). Of ESP-KTRs, 97.5% who underwent transplantation would again do so. CONCLUSIONS Long-term outcomes of ESP-KTRs ultimately support the effectiveness of an age-matched allocation system. Our data suggest that the survival advantage of women is maintained after kidney transplantation and calls for gender-specific care.
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Affiliation(s)
- Thomas Schachtner
- Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Berlin, Germany
- Berlin-Brandenburg Center of Regenerative Therapies, Berlin, Germany
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Natalie M Otto
- Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Berlin, Germany
- Berlin-Brandenburg Center of Regenerative Therapies, Berlin, Germany
| | - Petra Reinke
- Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Berlin, Germany
- Berlin-Brandenburg Center of Regenerative Therapies, Berlin, Germany
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Plage H, Pielka P, Liefeldt L, Budde K, Ebbing J, Sugünes N, Miller K, Cash H, Bichmann A, Sattler A, Kotsch K, Friedersdorff F. Extended Criteria Donors in Living Kidney Transplantation Including Donor Age, Smoking, Hypertension and BMI. Ther Clin Risk Manag 2020; 16:787-793. [PMID: 32922016 PMCID: PMC7455534 DOI: 10.2147/tcrm.s256962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/14/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose An expansion of selection criteria for deceased organ transplantation already exists to manage the current donor shortage. Comparable evaluation of risk factors for living donors should be investigated to improve this issue. Patients and Methods Our retrospective single-centre study analysed 158 patients with living kidney transplants performed between February 2006 and June 2012. We investigated the influence of donor risk factors (RF) including body mass index over 30 kg/m2, age >60 years, active nicotine abuse and arterial hypertension on postoperative kidney function with focus on the recipients. This was measured for long-term survival and glomerular filtration rate (GFR) in a 5-year follow-up. Results Overall, out of 158 living donors, 84 donors were identified to have no risk factors, whereas 74 donors had at least one risk factor. We noted a significant higher delayed graft function (p=0.042) in the first 7 days after transplantation, as well as lower GFR of recipients of allografts with risk factors in the first-year after transplantation. In our long-term results, there was no significant difference in the functional outcome (graft function, recipient and graft survival) between recipients receiving kidneys from donors with no and at least one risk factors. In the adjusted analysis of subgroups of different risk factors, recipients of donors with “age over 60 years” at time of transplantation had a decreased transplant survival (p=0.014). Conclusion Thus, a careful expansion for selection criteria for living donors with critical evaluation could be possible, but especially the age of the donors could be a limited risk factor.
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Affiliation(s)
- Henning Plage
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Poline Pielka
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Lutz Liefeldt
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Jan Ebbing
- Department of Urology, University Hospital Basel, Urological University Clinic Basel-Liestal, Basel, Switzerland
| | - Nesrin Sugünes
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Anna Bichmann
- Department of Anaesthesia and Operative Intensive Care Medicine, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Arne Sattler
- Department of General, Visceral- and Vascular Surgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katja Kotsch
- Department of General, Visceral- and Vascular Surgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Abeling T, Scheffner I, Karch A, Broecker V, Koch A, Haller H, Schwarz A, Gwinner W. Risk factors for death in kidney transplant patients: analysis from a large protocol biopsy registry. Nephrol Dial Transplant 2020; 34:1171-1181. [PMID: 29860340 DOI: 10.1093/ndt/gfy131] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Identification and quantification of the relevant factors for death can improve patients' individual risk assessment and decision-making. We used a well-documented patient cohort (n = 892) in a renal transplant programme with protocol biopsies to establish multivariable Cox models for risk assessment at 3 and 12 months post-transplantation. METHODS Patients transplanted between 2000 and 2007 were observed up to 11 years (total observation 5227 patient-years; median 5.9 years). Loss to follow-up was negligible (n = 15). A total of 2251 protocol biopsies and 1214 biopsies for cause were performed. All rejections and clinical borderline rejections in protocol biopsies were treated. RESULTS Overall 10-year patient survival was 78%, with inferior survival of patients with graft loss and superior survival of patients with living-donor transplantation. Eight factors were common in the models at 3 and 12 months, including age, pre-transplant heart failure and a score of cardiovascular disease and type 2 diabetes, post-transplant urinary tract infection, treatment of rejection, new-onset heart failure, coronary events and malignancies. Additional variables of the model at 3 months included deceased donor transplantation, transplant lymphocele, BK virus nephropathy and severe infections. Graft function and graft loss were significant factors of the model at 12 months. Internal validation and validation with a separate cohort of patients (n = 349) demonstrated good discrimination of the models. CONCLUSIONS The identified factors indicate the important areas that need special attention in the pre- and post-transplant care of renal transplant patients. On the basis of these models, we provide nomograms as a tool to weigh individual risks that may contribute to decreased survival.
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Affiliation(s)
- Tanja Abeling
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Irina Scheffner
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Annika Karch
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Verena Broecker
- Department of Clinical Pathology and Genetics, University of Gothenburg, Gothenburg, Sweden
| | - Armin Koch
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Hermann Haller
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Anke Schwarz
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Wilfried Gwinner
- Department of Nephrology, Hannover Medical School, Hannover, Germany
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9
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Quast LS, Grzella S, Lengenfeld T, Pillokeit N, Hummels M, Zgoura P, Westhoff TH, Viebahn R, Schenker P. Outcome of Kidney Transplantation Using Organs From Brain-dead Donors Older Than 75 Years. Transplant Proc 2019; 52:119-126. [PMID: 31901319 DOI: 10.1016/j.transproceed.2019.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/23/2019] [Accepted: 11/10/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE We investigated whether older donor kidneys aged >75 years have acceptable long-term function and if recipients can benefit sufficiently from the transplantation. METHODS This single-center study retrospectively analyzed patient data from 217 deceased donor kidney transplants performed between 1998 and 2014 as part of the Eurotransplant Senior Program, where the organ donors were ≥65 years old. Depending on donor age, the groups "older donors" (OD; n = 161) and "very old donors" (VOD; n = 56) received transplants from donors aged 65 to 75 years and >75 years, respectively. Donor and recipient clinical characteristics, delayed graft function, estimated glomerular filtration rate, 1-year rejection rate, patient and graft survival, and postoperative complications were investigated. RESULTS Comparing VOD group vs OD group, the 1-year, 3-year, and 5-year graft survival rates were 80.4% vs 76.4%, 62.5% vs 65.8%, and 42.6% vs 57.3%, respectively. Patient survival rates after 1, 3, and 5 years were 89.3% vs 88.2%, 71.4% vs 78.2%, and 57.5% vs 71.8%, respectively. There were no significant differences between the 2 groups (graft survival P = .107; patient survival P = .126). Kidney graft function after 1, 2, and 3 years was significantly better in the OD group than in the VOD group. No differences were found regarding postoperative complications, rejection rate, and delayed graft function. CONCLUSION The utilization of selected kidney-grafts from donors >75 years resulted in acceptable outcomes after kidney transplantation and could expand the donor pool. In contrast to the high mortality rate during dialysis, recipients in both groups benefited from transplantation.
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Affiliation(s)
- Louisa Sarah Quast
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Sascha Grzella
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Thorsten Lengenfeld
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Nina Pillokeit
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Marielle Hummels
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Panagiota Zgoura
- Medical Department I, University Hospital Marienhospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Timm H Westhoff
- Medical Department I, University Hospital Marienhospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Richard Viebahn
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Peter Schenker
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany.
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10
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Khalid U, Jameel M, Sabah T, Szabo L, Ilham MA, Chavez R, Ablorsu E, Asderakis A. Older Donation After Circulatory Death Kidneys for Older Recipients: A Single-Center Experience. Transplant Proc 2019; 51:701-706. [PMID: 30979453 DOI: 10.1016/j.transproceed.2019.01.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/02/2019] [Accepted: 01/17/2019] [Indexed: 12/29/2022]
Abstract
The number of older patients is increasing on the transplant waiting list. Donation after circulatory death (DCD) kidney transplantation has increased, but there remains hesitancy in use of older DCD organs. The aim of this study was to evaluate outcomes of directing older DCD donor kidneys into older recipients. METHODS Patients 60 years or older who received transplants from DCD donors 60 years or older, between February 2010 and January 2014, were identified from a prospectively maintained database. RESULTS Over a 4-year period, 88 patients 60 years or older received DCD kidney transplants from donors 60 years or older. Of these 44 (55%) were 60 to 69 years old and 40 (45%) were 70 years or older. Median follow up was 63 months. Patient survival was 95% and 79% at 1 and 5 years, respectively, with a survival in those 70 years and older (69%) compared with those aged 60 to 69 (88%) years (P = .01). Censored for death graft survival was 94% and 80% at 1 and 5 years, respectively. Median estimated glomerular filtration rate at 12 months and 36 months was 36 mL/min (range, 11-70 mL/min) and 39.5 mL/min (range, 11-77 mL/min), respectively. CONCLUSIONS Older DCD kidneys, when transplanted into older recipients, result in good patient and graft survival and an acceptable graft function, especially considering their age. This represents a good use of this organ resource.
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Affiliation(s)
- U Khalid
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
| | - M Jameel
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - T Sabah
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - L Szabo
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - M A Ilham
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - R Chavez
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - E Ablorsu
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - A Asderakis
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
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11
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Butler CR, Perkins JD, Johnson CK, Blosser CD, Bakthavatsalam R, Leca N, Sibulesky L. Burden of excess mortality after implementation of the new kidney allocation system may be borne disproportionately by middle-aged recipients. PLoS One 2019; 14:e0210589. [PMID: 30677058 PMCID: PMC6345464 DOI: 10.1371/journal.pone.0210589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/25/2018] [Indexed: 11/19/2022] Open
Abstract
Under the new kidney allocation system (KAS), implemented in 2014, the distribution of the best quality donor kidney grafts shifted between age groups, but it is unclear whether this change translates to meaningful differences in post-transplant outcomes. We conducted a retrospective cohort study of 20,345 deceased donor kidney transplant recipients before and 4,605 recipients after implementation of the KAS using data from the United Network of Organ Sharing. Overall, two-year mortality was greater among recipients in the post-KAS era compared with the pre-KAS era (6.31% vs 5.91% respectively, [p = 0.01]), and two-year graft loss was not significantly different between eras (9.95% and 9.65%, respectively [p = 0.13]). In analysis stratified by age group (18-45, 46-55, 56-65, and ≥66 years), relative risk of mortality was 1.48 (95% confidence interval [CI] 1.09-1.98) among recipients 46-55 years old and 1.47 (95% CI 1.18-1.81) among recipients 56-65 years old. Relative risk of all-cause graft loss was 1.43 (95% CI 1.20-1.70) among recipients 56-65 years old. There were no significant differences in relative risk of mortality or graft loss associated with the KAS era among other age groups. After adjustment for recipient characteristics and characteristics of the changing donor pool, relative risk of two-year mortality and graft loss associated with the post-KAS era was attenuated for recipients aged 46-55 and 56-65 years, but remained statistically significant. In this early analysis after implementation of the KAS, there is suggestion that increased risk of mortality and graft loss may be disproportionately borne by middle-aged recipients, which is only partially accounted for by changes in recipient and donor characteristics. These findings signal a need to continue to monitor the effects of the KAS to ensure that allocation practices both maximize utility of the kidney graft pool and respect fairness between age groups.
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Affiliation(s)
- Catherine R. Butler
- Department of Medicine, Division of Nephrology, University of Washington Medical Center, Seattle, WA, United States America
| | - James D. Perkins
- Department of Surgery, Division of Transplant Surgery, University of Washington Medical Center, Seattle, WA, United States America
| | - Christopher K. Johnson
- Department of Medicine, Division of Nephrology, University of Washington Medical Center, Seattle, WA, United States America
| | - Christopher D. Blosser
- Department of Medicine, Division of Nephrology, University of Washington Medical Center, Seattle, WA, United States America
| | - Ramasamy Bakthavatsalam
- Department of Surgery, Division of Transplant Surgery, University of Washington Medical Center, Seattle, WA, United States America
| | - Nicolae Leca
- Department of Medicine, Division of Nephrology, University of Washington Medical Center, Seattle, WA, United States America
| | - Lena Sibulesky
- Department of Surgery, Division of Transplant Surgery, University of Washington Medical Center, Seattle, WA, United States America
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12
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Schamberger B, Lohmann D, Sollinger D, Stein R, Lutz J. Association of Kidney Donor Risk Index with the Outcome after Kidney Transplantation in the Eurotransplant Senior Program. Ann Transplant 2018; 23:775-781. [PMID: 30397188 PMCID: PMC6248015 DOI: 10.12659/aot.909622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background We evaluated the Kidney Donor Risk Index (KDRI) scoring system for kidney transplantation in the Eurotransplant Senior Program (ESP) that allocates kidneys from older donors to older recipients (≥65 years). Material/Methods We retrospectively analyzed data of 37 kidney transplant recipients and 36 kidney donors who participated in kidney transplantation program according to the ESP at our center from January 2004 until December 2013. Results Mean recipient and donor age was 67.9±2.6 and 70.5±4.0 years respectively. The mean KDRI score was 1.7±0.27. Uncensored graft survival after 1 year and 5 years was 64.2% and 53.7% respectively. Subgroup analysis showed that in kidney transplantation with KDRI >1.83, graft survival was significantly reduced compared to lower KDRI subgroups. KDRI was significantly correlated with serum creatinine level at discharge (r=0.4). Conclusions ESP kidneys represent a group of high-risk grafts with high KDRI scores. Higher KDRI scores in ESP kidneys was associated with reduced postoperative short-term and long-term graft outcomes. KDRI might be useful in decision-making for selecting donors for ESP kidney transplantation.
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Affiliation(s)
- Beate Schamberger
- Medical Clinic, Section of Nephrology and Infectious Diseases, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany
| | - Dario Lohmann
- Medical Clinic III, Section of Nephrology, University Hospital Frankfurt, Frankfurt, Germany
| | - Daniel Sollinger
- I Medical Clinic, Section of Nephrology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Raimund Stein
- Department of Pediatric Urology, University Medical Center Mannheim, Mannheim, Germany
| | - Jens Lutz
- Medical Clinic, Section of Nephrology and Infectious Diseases, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany
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13
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Abstract
Background Elderly patients are the fastest-growing group in need of renal transplantation. This study puts focus on renal transplant recipients in their 80th year or longer at time of engraftment. Is there evidence to support an absolute upper age limit for renal transplantation? Methods Recipients in their 80th year or longer, transplanted between 1983 and 2015, were included. Data were retrieved from the Norwegian Renal Registry in the end of October 2015. Graft and patient survivals were compared with recipients aged 70 to 79 years at transplantation. Results Forty-seven patients older than 79 years were transplanted in the defined period. Median age 80.1 years, 81% were men. Median time on dialysis before transplantation was 18.5 months. All patients received an allograft from a deceased donor (median donor age, 61.8 years). In the death-censored graft survival model, there was no statistical difference between the groups. We found improved patient and graft survivals after introduction of mycophenolate mofetil and induction with basiliximab. Patients transplanted before 2000 had increased risk of death compared with those transplanted after 2000 (hazard ratio, 3.2; 95% confidence interval, 1.2-8.7). Median uncensored graft survival for patients transplanted after the year 2000 was 5.0 year (95% confidence interval, 2.4-7.6). Median patient survival was 5.0 years (3.1-6.9) and 5-year patient survival was 55%. Conclusions Age by itself should not be an absolute contraindication against renal transplantation. An estimated 5-year survival rate of 55% post-engraftment for an 80-year-old patient is in our opinion more than acceptable. The authors reveal an estimated 5 years survival rate of 55% postengraftment for an 80 years old patient with end-stage renal disease. In carefully selected octogenarians, kidney transplantation has an acceptable estimated 5 years survival rate in their opinion.
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14
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Sutherland AI, IJzermans JNM, Forsythe JLR, Dor FJMF. Kidney and liver transplantation in the elderly. Br J Surg 2015; 103:e62-72. [PMID: 26662845 DOI: 10.1002/bjs.10064] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transplant surgery is facing a shortage of deceased donor organs. In response, the criteria for organ donation have been extended, and an increasing number of organs from older donors are being used. For recipients, the benefits of transplantation are great, and the growing ageing population has led to increasing numbers of elderly patients being accepted for transplantation. METHODS The literature was reviewed to investigate the impact of age of donors and recipients in abdominal organ transplantation, and to highlight aspects of the fine balance in donor and recipient selection and screening, as well as allocation policies fair to young and old alike. RESULTS Overall, kidney and liver transplantation from older deceased donors have good outcomes, but are not as good as those from younger donors. Careful donor selection based on risk indices, and potentially biomarkers, special allocation schemes to match elderly donors with elderly recipients, and vigorous recipient selection, allows good outcomes with increasing age of both donors and recipients. The results of live kidney donation have been excellent for donor and recipient, and there is a trend towards inclusion of older donors. Future strategies, including personalized immunosuppression for older recipients as well as machine preservation and reconditioning of donor organs, are promising ways to improve the outcome of transplantation between older donors and older recipients. CONCLUSION Kidney and liver transplantation in the elderly is a clinical reality. Outcomes are good, but can be optimized by using strategies that modify donor risk factors and recipient co-morbidities, and personalized approaches to organ allocation and immunosuppression.
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Affiliation(s)
- A I Sutherland
- Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J N M IJzermans
- Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J L R Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - F J M F Dor
- Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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15
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VanWagner LB, Skaro AI. Should age matter? A new proposal for liver transplantation allocation. Liver Transpl 2015; 21:1235-7. [PMID: 26249554 DOI: 10.1002/lt.24225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Lisa B VanWagner
- Division of Gastroenterology and Hepatology, Department of Medicine, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Department of Preventive Medicine, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anton I Skaro
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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16
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17
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De Rosa P, Muscogiuri G, Sarno G. Expanded Criteria Donors in Kidney Transplantation: The Role of Older Donors in a Setting of Older Recipients. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/301025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Kidney transplantation (KT) is the therapy of choice for end-stage renal disease (ESRD). The ESRD population is aging and so are patients waiting for KT. New strategies have been made for increasing the donor and recipient pools, and as a consequence kidneys from older donors or donors with significant comorbidities, the so-called “expanded criteria donor” (ECD) kidneys, are used for transplantation. Although good outcomes have been achieved from ECD, several issues are still waiting for clarification and need to be discussed. The concept of age matching is accepted as a method to ameliorate utilization of these allografts, but an optimal and widely accepted strategy is still not defined. The development of machine perfusion and the dual kidney transplantation are techniques which further improve the outcome of transplants from ECD, but the described experiences are scarce or coming from small single institutional reports. Also due to age-related immune dysfunction and associated comorbidities, the elderly recipients are more susceptible to immunosuppression related complications (e.g., infections and malignancy), although a widely accepted and validated immunosuppressive regimen is still lacking. In this paper, we review the issues related to KT employing allografts from marginal donors with a particular interest for the elderly patients.
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Affiliation(s)
- Paride De Rosa
- Department of General Surgery and Transplantation Unit, “San Giovanni di Dio e Ruggi D’Aragona” University Hospital, Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy
| | - Giovanna Muscogiuri
- Division of Endocrinology and Metabolic Diseases, Catholic University of the Sacred Heart “Agostino Gemelli” University Hospital, Rome, Italy
| | - Gerardo Sarno
- Department of General Surgery and Transplantation Unit, “San Giovanni di Dio e Ruggi D’Aragona” University Hospital, Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy
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18
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Shin M, Park JB, Kwon CHD, Joh JW, Lee SK, Kim SJ. Enhanced Significance of Donor–Recipient Age Gradient as a Prognostic Factor of Graft Outcome in Living Donor Kidney Transplantation. World J Surg 2013; 37:1718-26. [DOI: 10.1007/s00268-013-2038-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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Morales JM, Marcén R, del Castillo D, Andres A, Gonzalez-Molina M, Oppenheimer F, Serón D, Gil-Vernet S, Lampreave I, Gainza FJ, Valdés F, Cabello M, Anaya F, Escuin F, Arias M, Pallardó L, Bustamante J. Risk factors for graft loss and mortality after renal transplantation according to recipient age: a prospective multicentre study. Nephrol Dial Transplant 2012; 27 Suppl 4:iv39-46. [PMID: 23258810 PMCID: PMC3526982 DOI: 10.1093/ndt/gfs544] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/18/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To describe the causes of graft loss, patient death and survival figures in kidney transplant patients in Spain based on the recipient's age. METHODS The results at 5 years of post-transplant cardiovascular disease (CVD) patients, taken from a database on CVD, were prospectively analysed, i.e. a total of 2600 transplanted patients during 2000-2002 in 14 Spanish renal transplant units, most of them receiving their organ from cadaver donors. Patients were grouped according to the recipient's age: Group A: <40 years, Group B: 40-60 years and Group C: >60 years. The most frequent immunosuppressive regimen included tacrolimus, mycophenolate mofetil and steroids. RESULTS Patients were distributed as follows: 25.85% in Group A (>40 years), 50.9% in Group B (40-60 years) and 23.19% in Group C (>60). The 5-year survival for the different age groups was 97.4, 90.8 and 77.7%, respectively. Death-censored graft survival was 88, 84.2 and 79.1%, respectively, and non death-censored graft survival was 82.1, 80.3 and 64.7%, respectively. Across all age groups, CVD and infections were the most frequent cause of death. The main causes of graft loss were chronic allograft dysfunction in patients <40 years old and death with functioning graft in the two remaining groups. In the multivariate analysis for graft survival, only elevated creatinine levels and proteinuria >1 g at 6 months post-transplantation were statistically significant in the three age groups. The patient survival multivariate analysis did not achieve a statistically significant common factor in the three age groups. CONCLUSIONS Five-year results show an excellent recipient survival and graft survival, especially in the youngest age group. Death with functioning graft is the leading cause of graft loss in patients >40 years. Early improvement of renal function and proteinuria together with strict control of cardiovascular risk factors are mandatory.
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Affiliation(s)
| | - Roberto Marcén
- Department of Nephrology, Hospital Ramon y Cajal, Madrid, Spain
| | | | - Amado Andres
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Daniel Serón
- Department of Nephrology, Hospital Vall d Hebron, Barcelona, Spain
| | | | | | | | - Francisco Valdés
- Department of Nephrology, Hospital Juan Canalejo, La Coruña, Spain
| | | | - Fernando Anaya
- Department of Nephrology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Manuel Arias
- Department of Nephrology, Hospital Marqués de Valdecilla, Santander, Spain
| | - Luis Pallardó
- Department of Nephrology, Hospital Dr Peset, Valencia, Spain
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20
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Kim YS, Kim SI, Kim MS, Huh KH, Ju MK, Joo DJ, Kim HJ, Jeon KO, Kim HJ, Park K. Evaluation of Independent Risk Factors Affecting Renal Allograft Survival by Transplant Era. KOREAN JOURNAL OF TRANSPLANTATION 2012. [DOI: 10.4285/jkstn.2012.26.3.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yu Seun Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Ha Huh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Man Ki Ju
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Jin Joo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Hae-Jin Kim
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Ock Jeon
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Kiil Park
- Department of Surgery, Bundang CHA Hospital, CHA University College of Medicine, Seongnam, Korea
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21
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Gallinat A, Moers C, Treckmann J, Smits JM, Leuvenink HGD, Lefering R, van Heurn E, Kirste GR, Squifflet JP, Rahmel A, Pirenne J, Ploeg RJ, Paul A. Machine perfusion versus cold storage for the preservation of kidneys from donors >=65 years allocated in the Eurotransplant Senior Programme. Nephrol Dial Transplant 2012; 27:4458-63. [DOI: 10.1093/ndt/gfs321] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Brännström M, Diaz-Garcia C, Hanafy A, Olausson M, Tzakis A. Uterus transplantation: animal research and human possibilities. Fertil Steril 2012; 97:1269-76. [PMID: 22542990 DOI: 10.1016/j.fertnstert.2012.04.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
Abstract
Uterus transplantation research has been conducted toward its introduction in the human as a treatment of absolute uterine-factor infertility, which is considered to be the last frontier to conquer for infertility research. In this review we describe the patient populations that may benefit from uterus transplantation. The animal research on uterus transplantation conducted during the past two decades is summarized, and we describe our views regarding a future research-based human attempt.
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Affiliation(s)
- Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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23
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Lim WH, Dogra G, Chadban SJ, Campbell SB, Clayton P, Cohney S, Russ GR, McDonald SP. Lack of impact of donor age on patient survival for renal transplant recipients ≥60years. Transpl Int 2012; 25:401-8. [PMID: 22340432 DOI: 10.1111/j.1432-2277.2012.01429.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There has been an increase in the number of older patients on the transplant waiting list and acceptance of older donor kidneys. Although kidneys from older donors have been associated with poorer graft outcomes, whether there is a differential impact of donor age on outcomes in older recipients remains unclear. The aim of this study was to evaluate the effect of donor age on graft and patient survival in renal transplant (RT) recipients ≥60years. Using the Australia and New Zealand Dialysis and Transplant Registry, outcomes of 1,037 RT recipients ≥60years between 1995 and 2009 were analyzed. Donor age groups were categorized into 0-20, >20-40, >40-60, and >60years. Compared with recipients receiving donor kidneys >60years, those receiving donor kidneys >20-40years had lower risk of acute rejection (odds ratio 0.46, 95% CI 0.27, 0.79; P<0.01) and death-censored graft failure (HR 0.37, 95% CI 0.19, 0.72; P<0.01). There was no association between donor age groups and death. With a corresponding growth in the availability of older donor kidneys and the observed lack of association between donor age and patient survival in RT recipients ≥60years, preferential allocation of older donor kidneys to RT recipients ≥60years may not disadvantage the life expectancy of these patients.
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Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
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24
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Hopper K, Mehl ML, Kass PH, Kyles A, Gregory CR. Outcome after Renal Transplantation in 26 Dogs. Vet Surg 2012; 41:316-27. [DOI: 10.1111/j.1532-950x.2011.00924.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Kate Hopper
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California-Davis; Davis; CA
| | - Margo L. Mehl
- San Francisco Veterinary Specialists; San Francisco; CA
| | - Philip H. Kass
- Department of Population Health and Reproduction; School of Veterinary Medicine; University of California-Davis; Davis; CA
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25
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Single-center experience with kidney transplantation using deceased donors older than 75 years. Transplantation 2011; 92:76-81. [PMID: 21546867 DOI: 10.1097/tp.0b013e31821d2687] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Use of kidneys from donors aged 75 years and older is controversial. The purpose of this study was to evaluate the outcome of kidney transplantation (KT) involving these expanded criteria donors. MATERIALS AND METHODS From January 2001 to November 2009, 52 patients were transplanted with grafts from deceased donors aged 75 years and older. Donor and recipient data and intra- and postoperative variables were analyzed by univariate and multivariate regression analyses. Graft and patient survival were calculated using the Kaplan-Meier method. RESULTS Forty-one single and 11 double KTs were performed. Median recipient age was 66 years. After a median follow-up of 30 months, 37 of 52 patients are alive, 30 with functioning grafts (81%). Graft and patient survival rates at 3 and 5 years are 63% and 53%, and 78% and 64%, respectively. Double KT was significant predictor for graft survival by multivariate analysis. Five-year graft survival for single and double KT was 41% and 90%, respectively (P=0.0394). Comorbidity Index, hospital stay, acute rejection reaction, re-KT, and induction immunosuppressive therapy with interleukin-2 were significant predictors for patient survival by univariate analysis. Hospital stay and induction immunosuppression therapy reached multivariate significance. Double KT, cold ischemia time, and Comorbidity Index were found potential predictors of delayed graft function in our series. CONCLUSIONS Fairly good long-term outcome of KT from donors aged 75 years and older can be achieved in elderly recipients with low comorbidities when dual kidney grafting is used and when re-transplantations and high grade surgical complications are avoided.
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26
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Long-Term Outcome in Kidney Transplant Recipients Over 70 Years in the Eurotransplant Senior Kidney Transplant Program: A Single Center Experience. Transplantation 2011; 92:210-6. [DOI: 10.1097/tp.0b013e318222ca2f] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Lim WH, Chang S, Chadban S, Campbell S, Dent H, Russ GR, McDonald SP. Donor-recipient age matching improves years of graft function in deceased-donor kidney transplantation. Nephrol Dial Transplant 2010; 25:3082-9. [PMID: 20736266 DOI: 10.1093/ndt/gfq127] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Donor and recipient age in kidney transplantation are known to affect graft and patient survival. In deceased-donor (DD) transplantation, donor and recipient age matching are being increasingly accepted as part of the kidney allocation programme. The aims of this study are to evaluate the effect of donor and recipient age on transplant outcomes and to determine the effect of changing existing allocation criteria to allocation based on age matching of donors and recipients on total graft years of function. METHODS Using the Australia and New Zealand Dialysis and Transplant Registry, all DD kidney transplant recipients in Australia and New Zealand between 1991 and 2006 were analysed (n = 4616). Outcomes analysed were overall graft failure, death with functioning graft and serum creatinine. We calculated the mean time to graft loss ('years of graft function') for donor and recipient age cut-offs as 60 and 55 years, respectively, over up to 16 years follow-up. We then examined the gain in graft years if all older kidneys were allocated to older recipients. RESULTS Older donors were associated with higher risk of overall graft failure [adjusted hazard ratio (HR) = 1.79, 95% confidence interval (95% CI) = 1.45, 2.21 and HR = 1.29, 95% CI = 1.09, 1.53, respectively] at 1-8 years post-transplant and higher serum creatinine at 1 and 5 years post-transplant (mean differences 32.74 micromol/L, 95% CI 27.60, 37.89 and 38.17 micromol/L, 95% CI 27.58, 48.77, respectively). Overall, young and old recipients with young donor kidneys have an additional two to three mean graft years compared to those receiving older donor kidneys. CONCLUSION Donor and recipient age matching is an effective method of organ allocation to improve total graft years.
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Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
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A randomized trial comparing renal function in older kidney transplant patients following delayed versus immediate tacrolimus administration. Transplantation 2010; 88:1101-8. [PMID: 19898206 DOI: 10.1097/tp.0b013e3181ba06ee] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This large, randomized, multicenter trial evaluated if basiliximab induction and delayed tacrolimus can preserve renal function in older kidney transplant patients. METHODS Patients aged 60 years and older received delayed tacrolimus with basiliximab and mycophenolate mofetil with early steroid discontinuation (Tac-d, n=132) or standard tacrolimus with mycophenolate mofetil and steroids until day 91 (Tac-s, n=122). Tacrolimus trough levels were 5 to 10 ng/mL after day 43 in both groups. Renal function at month 6 was measured by calculated creatinine clearance (Cockcroft-Gault formula). RESULTS In both groups, mean recipient age was 66 years, mean donor age was 63 years with 73% of donors aged 60 years and older. Steroid discontinuation was slower than protocol specified. In the Tac-d group, 56.1% were steroid free at day 14 and 81.8% at month 6. In the Tac-s group, 37.7% were steroid free at month 4 and 63.9% at month 6. Mean (+/-SD) calculated creatinine clearance was 45.7+/-16.1 mL/min (Tac-d) and 45.0+/-18.2 mL/min (Tac-s) (P=ns), mean glomerular filtration rate (modified diet in renal disease formula) was 44.9+/-16.2 mL/min and 41.6+/-16.8 mL/min, respectively. Incidences of biopsy-proven acute rejection were 18.9% (Tac-d) and 18.0% (Tac-s). Delayed graft function was 30.3% (Tac-d) and 23.8% (Tac-s). Estimated patient survival rates (Kaplan-Meier) in the Tac-d and Tac-s groups were 96.1% vs. 99.2% and estimated graft survival rates were 90% vs. 87.6%, respectively. Safety results were similar with both regimens. CONCLUSION Delayed tacrolimus with basiliximab induction did not provide an advantage in preserving renal function or reducing delayed graft function in older kidney transplant patients.
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Giessing M, Fuller TF, Friedersdorff F, Deger S, Wille A, Neumayer HH, Schmidt D, Budde K, Liefeldt L. Outcomes of transplanting deceased-donor kidneys between elderly donors and recipients. J Am Soc Nephrol 2008; 20:37-40. [PMID: 19073824 DOI: 10.1681/asn.2008040423] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Rate of acceptance of deceased-donor kidneys decreases with donor age despite the growing number of aged transplant candidates on the waiting list. In the Eurotransplant Senior Program, HLA-unmatched kidneys from deceased donors aged > or = 65 yr are transplanted regionally into recipients aged > or = 65 yr. Because we have become more willing to accept kidneys from donors aged > or = 75 yr than previous years, we performed a retrospective analysis of this subgroup. Kidneys were accepted from donors aged > or = 75 yr provided a normal creatinine on admission to the hospital, a Cockcroft-Gault creatinine clearance > 80 ml/min, and an absence of comorbidities. We compared outcomes of kidneys from donors aged > or = 75 yr with both younger-donor kidneys transplanted in the Eurotransplant Senior Program and with younger-donor HLA-matched kidneys transplanted into recipients > or = 60 yr. There were no differences in 5-yr graft and patient survival or rate of delayed graft function between groups. Graft function, measured by creatinine and creatinine clearance, differed without pattern at only three of 12 time points during 5 yr of follow-up. In conclusion, our data suggest that kidneys from deceased donors aged > or = 75 yr can be transplanted safely into recipients aged > or = 65 yr if similar donor criteria and local allocation practices are used.
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Affiliation(s)
- Markus Giessing
- Department of Urology, Heinrich Heine University Hospital, Moorenstr. 5, D-40225 Duesseldorf, Germany.
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Basic-Jukic N, Furic-Cunko V, Kes P, Bubic-Filipi L, Pasini J, Hudolin T, Juric I. Outcome After Renal Transplantation in a “Senior” Program: The Croatian Experience. Transplant Proc 2008; 40:3418-21. [DOI: 10.1016/j.transproceed.2008.06.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 06/13/2008] [Accepted: 06/18/2008] [Indexed: 11/30/2022]
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Guba M, Rentsch M, Wimmer CD, Uemueksuez A, Illner WD, Schönermarck U, Land WG, Jauch KW, Arbogast H. Calcineurin-inhibitor avoidance in elderly renal allograft recipients using ATG and basiliximab combined with mycophenolate mofetil. Transpl Int 2008; 21:637-45. [PMID: 18282242 DOI: 10.1111/j.1432-2277.2008.00658.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In old recipients of renal allografts from old donors, benefits of calcineurin-inhibitors (CNI) are curtailed by nephrotoxicity. Intending to improve the outcome of these recipients, we analyzed a CNI-free immunosuppressive regimen consisting of anti-thymocyte globulin (ATG), basiliximab, mycophenolate mofetil (MMF) and steroids. Kidney allograft recipients with low immunological risk (panel reactive antibodies <30%) were eligible for this study. Immunosuppression induction included ATG (4 mg/kg, day 0), basiliximab (20 mg, day 0 + 4) and steroids, followed by MMF (TL 2-6 microg/ml) and steroid maintenance treatment. Patient and graft survival rates respectively were 89.3% and 85.4% (12 months), and 86.6% and 76.8% (24 months). Delayed graft function occurred in 44.6%. S-creatinine at 12 months was 1.85 +/- 0.94 mg/dl. Thirty patients (53.6%) showed biopsy-proven rejections (6x Banff 3, 13x Banff 4I and 16x Banff 4II), 77% of which were steroid-sensitive, 23% required antibody treatment. After 12 months, 83% of the patients had an MMF-based immunosuppression, 43% were CNI-free. Cytomegalovirus (CMV) infections occurred in 28, tissue-invasive disease in three patients. Despite acceptable renal graft survival and function in some of patients with marginal organs, high incidences of rejections and CMV infections suggest the feasibility of CNI-avoidance using an MMF-based protocol only in carefully selected patients.
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Affiliation(s)
- Markus Guba
- Department of Surgery, Klinikum Grosshadern, University of Munich, Munich, Germany.
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Frei U, Noeldeke J, Machold-Fabrizii V, Arbogast H, Margreiter R, Fricke L, Voiculescu A, Kliem V, Ebel H, Albert U, Lopau K, Schnuelle P, Nonnast-Daniel B, Pietruck F, Offermann R, Persijn G, Bernasconi C. Prospective age-matching in elderly kidney transplant recipients--a 5-year analysis of the Eurotransplant Senior Program. Am J Transplant 2008; 8:50-7. [PMID: 17973969 DOI: 10.1111/j.1600-6143.2007.02014.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Renal transplantation faces challenges: the organ shortage resulting in extended waiting times and an aging population resulting in death with a functioning graft. The Eurotransplant Senior Program (ESP) allocates kidneys within a narrow geographic area from donors aged >/=65 years to recipients >/=65 years regardless of HLA. This analysis investigates the impact of the ESP on waiting time, graft and patient survival. The ESP group (n = 1406, old to old) was compared to two groups allocated via the Eurotransplant Kidney Allocation System (ETKAS) with either similar donor age (old to any [O/A], donor age >/=65, n = 446) or recipient age (any to old, [A/O], recipient age 60-64, n = 1687). All patients were transplanted between 1999 and 2004. Since initiation of the ESP (1999), availability of elderly donors doubled and waiting time for ESP patients decreased. Local allocation led to shorter cold ischemia time (11.9 vs. >17.0 h, p < 0.001) and less delayed graft function (DGF, ESP 29.7% vs. O/A 36.2%, p = 0.047) but 5-10% higher rejection rates. Graft and patient survival were not negatively affected by the ESP allocation when compared to the standard allocation. The ESP age matching of elderly donors and recipients is an effective allocation system for organs from elderly donors.
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Affiliation(s)
- U Frei
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charité Campus-Virchow-Klinikum, Berlin, Germany.
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Vacher-Coponat H, Purgus R, Indreies M, Moal V, Luciani H, Lechevallier E, Delaporte V, Luccioni A, Julian H, Reviron D, Dussol B, Berland Y. Cold Ischemia Time in Renal Transplantation Is Reduced by a Timesheet in a French Transplant Center. Transplantation 2007; 83:561-5. [PMID: 17353774 DOI: 10.1097/01.tp.0000253757.14344.7f] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cold ischemia time (CIT) is associated with delayed graft function (DGF) and transplant outcome. Several strategies to reduce CIT have been proposed. We retrospectively analyzed the effect of using a timesheet on CIT in our center. METHODS In the last 2 years, we have introduced a timesheet to study the course of organ procurement and transplantation during CIT. Results of our 2-year program (121 transplantations) were compared to those in the preceding 2 years (151 transplantations). The timing of each intervention and the influence of national sharing policy and priority recipients were recorded. RESULTS CIT decreased significantly from 21.45 to 13.27 hours (P<0.0001) and the DGF rate from 34.7 to 20.7% (P=0.011). Usually, human leukocyte antigen typing was done before kidney removal and the recipient was evaluated in the evening or at night for a transplant procedure starting in the morning. Only 1 of 121 transplantations started during the night. The availability of an operating room was the limiting factor. Sharing organs for national priority with a crossmatch having been performed increased CIT twofold (P<0.0001). CONCLUSION Using a timesheet significantly reduced CIT to the shortest in France. The timesheet is an indicator of motivation and requires the collaboration of all transplantation personnel. It identified certain habits that may be improved to minimize CIT without reorganizing the unit. Providing quicker access to the operating room should further reduce CIT, the key to better graft survival.
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Affiliation(s)
- Henri Vacher-Coponat
- Centre de Néphrologie et Transplantation Rénale, Hôpital Conception, Marseille, France.
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Denecke C, Habicht A, Chandraker A, Tullius SG. The impact of donor age and recipient age on clinical course and immune response after organ transplantation. Transplant Rev (Orlando) 2006. [DOI: 10.1016/j.trre.2006.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Bodingbauer M, Pakrah B, Steininger R, Berlakovich G, Rockenschaub S, Wekerle T, Muehlbacher F. The advantage of allocating kidneys from old cadaveric donors to old recipients: a single-center experience. Clin Transplant 2006; 20:471-5. [PMID: 16842524 DOI: 10.1111/j.1399-0012.2006.00508.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In January 1999 a new kidney allocation program was launched by the Eurotransplant Foundation, the 'Eurotransplant Senior Program' (ESP). Cadaveric donors above the age of 65 yr are allocated to kidney transplant recipients of the same age group. METHODS Using a single-center database, 91 patients who underwent first renal transplantation at the age of 65 yr and older in the years 1999-2002 were identified. Fifty-six patients were transplanted through ESP allocation (study group) and 35 patients (control group) via normal Eurotransplant Kidney Allocation System (ETKAS) procedure. RESULTS Age, sex and comorbid conditions did not differ by group. The rate of acute rejection episodes, primary non-function, delayed graft function, perioperative mortality did not differ by group. Serum creatinine was significantly lower in the ETKAS group (1.3 vs. 1.9 mg/dL; p=0.015) from six months after the transplantation on. Overall graft survival at six yr was 56% in the ETKAS group and 52% in the ESP group. With 73% in the ETKAS group and 71% in the ESP group, cumulative patient survival according to the Kaplan-Meier estimation was not statistically different at five yr. CONCLUSIONS We did not find a relevant difference in the outcome between young and old kidney transplants in old recipients after this long observation period.
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Affiliation(s)
- M Bodingbauer
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria.
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Rerolle JP, Szelag JC, Diaconita M, Saada F, Aldigier JC, Le Meur Y. Transplantation rénale du sujet âgé. Nephrol Ther 2006; 2:8-14. [PMID: 16895710 DOI: 10.1016/j.nephro.2005.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Revised: 12/03/2005] [Accepted: 12/28/2005] [Indexed: 11/21/2022]
Abstract
For ten years, an increase in the number of elderly patients on renal transplant waiting lists has occured. In an attempt to close the widening gap between supply and demand and because the demand for kidneys for younger patients already surpasses the supply, transplant physicians nowadays accept organs from older donors that might have been deemed inappropriate in the past. Programs of age matching between donors and recipients and of dual-kidneys transplantation have emerged. The initial results of these programs are encouraging with excellent patient and graft survival at one and three years.
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Affiliation(s)
- Jean-Philippe Rerolle
- Service de Néphrologie et Transplantation Rénale, CHRU Dupuytren, Martin-Luther-King, Limoges, France.
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