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Sharif A. Deceased Donor Characteristics and Kidney Transplant Outcomes. Transpl Int 2022; 35:10482. [PMID: 36090778 PMCID: PMC9452640 DOI: 10.3389/ti.2022.10482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022]
Abstract
Kidney transplantation is the therapy of choice for people living with kidney failure who are suitable for surgery. However, the disparity between supply versus demand for organs means many either die or are removed from the waiting-list before receiving a kidney allograft. Reducing unnecessary discard of deceased donor kidneys is important to maximize utilization of a scarce and valuable resource but requires nuanced decision-making. Accepting kidneys from deceased donors with heterogenous characteristics for waitlisted kidney transplant candidates, often in the context of time-pressured decision-making, requires an understanding of the association between donor characteristics and kidney transplant outcomes. Deceased donor clinical factors can impact patient and/or kidney allograft survival but risk-versus-benefit deliberation must be balanced against the morbidity and mortality associated with remaining on the waiting-list. In this article, the association between deceased kidney donor characteristics and post kidney transplant outcomes for the recipient are reviewed. While translating this evidence to individual kidney transplant candidates is a challenge, emerging strategies to improve this process will be discussed. Fundamentally, tools and guidelines to inform decision-making when considering deceased donor kidney offers will be valuable to both professionals and patients.
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Affiliation(s)
- Adnan Sharif
- Department of Nephrology and Transplantation, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Adnan Sharif,
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2
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Tandukar S, Wu C, Hariharan S, Puttarajappa C. Impact of Size Matching Based on Donor-Recipient Height on Kidney Transplant Outcomes. Transpl Int 2022; 35:10253. [PMID: 35572466 PMCID: PMC9099356 DOI: 10.3389/ti.2022.10253] [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: 11/19/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022]
Abstract
Transplantation of kidneys from shorter donors into taller recipients may lead to suboptimal allograft survival. The effect of discrepancy in donor and recipient heights (ΔHeight) on long term transplant outcomes is not known. Adult patients ≥18 years undergoing living or deceased donor (LD or DD) kidney transplants alone from donors ≥18 years between 2000 and 2016 in the United States were included in this observational study. The cohort was divided into three groups based on ΔHeight of 5 inches as 1) Recipient < Donor (DD: 31,688, LD: 12,384), 2) Recipient = Donor (DD: 84,711, LD: 54,709), and 3) Recipient > Donor (DD: 21,741, LD: 18,753). Univariate analysis showed a higher risk of DCGL and mortality in both DD and LD (p < 0.001 for both). The absolute difference in graft and patient survival between the two extremes of ΔHeight was 5.7% and 5.7% for DD, and 0.4% and 1.4% for LD. On multivariate analysis, the HR of DCGL for Recipient < Donor and Recipient > Donor was 0.95 (p = 0.05) and 1.07 (p = 0.01) in DD and 0.98 (p = 0.55) and 1.14 (p < 0.001) in LD. Similarly, the corresponding HR of mortality were 0.97 (p = 0.07) and 1.07 (p = 0.003) for DD and 1.01 (p < 0.001) and 1.05 (p = 0.13) for LD. For DGF, the HR were 1.04 (p = 0.1) and 1.01 (p = 0.7) for DD and 1.07 (p = 0.45) and 0.89 (p = 0.13) for LD. Height mismatch between the donor and recipient influences kidney transplant outcomes.
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Affiliation(s)
- Srijan Tandukar
- Willis-Knighton Medical Center, Shreveport, LA, United States
- *Correspondence: Srijan Tandukar,
| | - Christine Wu
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Lee JY, Cha SH, Kim SH, Jeong KH, Chung KY, Cho HR, Lee J, Huh KH, Yang J, Kim MS, Kim DG. Risk Due to ABO Incompatibility and Donor-Recipient Weight Mismatch in Living Donor Kidney Transplantation: A National Cohort Study. J Clin Med 2021; 10:jcm10235674. [PMID: 34884376 PMCID: PMC8658727 DOI: 10.3390/jcm10235674] [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: 11/05/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
The effect of donor-recipient weight mismatch is not well established in ABO-incompatible living donor kidney transplantation (LDKT). A total of 2584 LDKT patients in the Korean Organ Transplantation Registry were classified into four groups according to the presence or absence of ABO incompatibility and donor-recipient weight mismatch (donor-to-recipient weight ratio (DRWR) < 0.8). In a multivariable Cox analysis, the combination of ABO incompatibility and DRWR incompatibility (n = 124) was an independent risk factor for graft survival (HR = 2.73, 95% CI = 1.11-6.70) and patient survival (HR = 3.55, 95% CI = 1.39-9.04), whereas neither factor alone was a significant risk factor for either outcome. The combination of ABO incompatibility and DRWR incompatibility was not an independent risk factor for biopsy-proven graft rejection (HR = 1.27, 95% CI = 0.88-1.82); however, it was an independent risk factor for pneumonia (HR = 2.94, 95% CI = 1.64-5.57). The mortality rate due to infection was higher among patients with both ABO incompatibility and DRWR incompatibility than among patients with neither factor or with either factor alone. The combination of ABO incompatibility and DRWR incompatibility was an independent risk factor for graft and patient survival after LDKT, whereas neither factor alone significantly affected graft or patient survival. Thus, donor-recipient weight matching should be cautiously considered in LDKT with ABO incompatibility.
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Affiliation(s)
- Jun Young Lee
- Transplantation Center, Wonju Severance Christian Hospital, Wonju 26426, Korea;
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
| | - Sung Hwan Cha
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Sung Hwa Kim
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Kyung Hwan Jeong
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul 02447, Korea;
| | - Ku Yong Chung
- Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul 07985, Korea;
| | - Hong Rae Cho
- Department of Surgery, Ulsan University Hospital, Ulsan 44030, Korea;
| | - Juhan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea; (J.L.); (K.H.H.); (M.S.K.)
| | - Kyu Ha Huh
- Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea; (J.L.); (K.H.H.); (M.S.K.)
| | - Jaeseok Yang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea; (J.L.); (K.H.H.); (M.S.K.)
| | - Deok Gie Kim
- Transplantation Center, Wonju Severance Christian Hospital, Wonju 26426, Korea;
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
- Correspondence: ; Tel.: +82-33-741-0510
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Cetiner M, Paul A, Treckmann JW, Dittmann S, Büscher R, Hoyer PF, Büscher AK. Small donors for small recipients - excellent growth and long-term function of single kidney grafts. Transpl Int 2021; 34:2735-2745. [PMID: 34626504 DOI: 10.1111/tri.14129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 12/26/2022]
Abstract
Small-donor kidneys (≤20 kg donor weight, SDK) are preferably transplanted en bloc in adults. Concerns about thrombotic complications or hyperfiltration hinder their use in children, particularly as single grafts. Low centre experience and donor-to-recipient size are rated critical regarding outcomes. We evaluated SDK transplantation (SDTx) in paediatric recipients at a specialized transplant centre. Between 2008 and 2018, SDTx was performed in 40 children (mean age 5.4 ± 1.4 years, single grafts n = 38, donor weight ≤10 kg: n = 10). Perioperative complications were rare (n = 3), mainly thromboses despite immediate heparinization and resulted in graft loss in one patient. Overall, early and long-term GFR were excellent (76 ± 21 and 100 ± 11 ml/min/1.73 m2 , first month and year 5, respectively). Three patients presented with delayed graft function. Graft volume increased significantly (69 ± 38 vs. 111 ± 33 ml within 5 years; P < 0.0001). Patients showed catch-up growth to normal range (SDS for height -2.06 ± 1.6 to -1.60 ± 1.5). Stratification by recipient age and donor weight revealed superior results in young recipients (≤3 years) and ≤10 kg donors, respectively. Outcome of single SDK grafts was excellent. Gain of GFR and graft volume was even higher in patients with very small donor or recipient size, regardless of a reduced donor-to-recipient weight ratio. Therefore, SDTx should be considered favouring small paediatric recipients.
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Affiliation(s)
- Metin Cetiner
- Paediatric Nephrology, University Children's Hospital, University Duisburg-Essen, Essen, Germany
| | - Andreas Paul
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Juergen W Treckmann
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Susanne Dittmann
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Rainer Büscher
- Paediatric Nephrology, University Children's Hospital, University Duisburg-Essen, Essen, Germany
| | - Peter F Hoyer
- Paediatric Nephrology, University Children's Hospital, University Duisburg-Essen, Essen, Germany
| | - Anja K Büscher
- Paediatric Nephrology, University Children's Hospital, University Duisburg-Essen, Essen, Germany
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Pruett TL, Vece GR, Carrico RJ, Klassen DK. US deceased kidney transplantation: Estimated GFR, donor age and KDPI association with graft survival. EClinicalMedicine 2021; 37:100980. [PMID: 34386752 PMCID: PMC8343266 DOI: 10.1016/j.eclinm.2021.100980] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/20/2021] [Accepted: 06/04/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Despite a significant shortage of kidneys for transplantation in the US, kidneys from older deceased donors are infrequently transplanted. This is primarily over concern of graft quality and transplant durability. METHODS The US national transplant database (2000-2018) was assessed for deceased donor kidney transplant patient and graft survival, graft durability and stratified by donor age (<65 years>), Kidney Donor Profile Index (KDPI) and estimated glomerual filtration rate (GFR) one year post-transplantation (eGFR-1) were calculated. FINDINGS Recipients of kidneys transplanted from deceased donors >65 years had a lower eGFR-1, (median 39 ml/min) than recipients of younger donor kidneys (median 54 ml/min). However, death-censored graft survival, stratified by eGFR-1, demonstrated similar survival, irrespective of donor age or KDPI. The durability of kidney survival decreases as the achieved eGFR-1 declines. KDPI has a poor association with eGFR-1 and lesser for graft durability. While recipients of kidneys > 65 years had a higher one year mortality than younger kidney recipients, recipients of kidneys > 65 years and an eGFR-1 <30 ml/min, had a lower survival than an untransplanted waitlist cohort (p<0.001). INTERPRETATION The durability of kidney graft survival after transplantation was associated with the amount of kidney function gained through the transplant (eGFR-1) and the rate of graft loss (return to dialysis) was not significantly associated with donor age. 24.9% of recipients of older donor kidneys failed to achieve sufficient eGFR-1 providing a transplant survival benefit. While there is significant benefit from transplanting older kidneys, better decision-making tools are required to avoid transplanting kidneys that provide insufficient renal function. FUNDING None.
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Key Words
- AUC, area under curve
- Age
- CI, Confidence Interval
- CKD, chronic kidney disease
- CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration Equation
- CPRA, calculated panel-reactive antibody
- DCD, donation after circulatory death
- Donation
- ESRD, end stage renal disease
- Glomerular filtration rate (GFR)
- HHS, Department of Health and Human Services of the US government
- HRSA, Health Resources and Services Administration, Agency within HHS
- KDIGO, Kidney Disease Improving Global Outcomes
- KDPI, kidney donor profile index
- KDRI, kidney donor risk index
- OPTN, Organ Procurement and Transplantation Network
- Outcomes
- Transplantation
- eGFR, estimated glomerular filtration rate
- eGFR-1, one year after transplantation
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Affiliation(s)
- Timothy L. Pruett
- Transplantation Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN 55455, United States
- Corresponding author.
| | - Gabriel R. Vece
- United Network for Organ Sharing, 700N 4th St, Richmond, VA 23219, United States
| | - Robert J. Carrico
- United Network for Organ Sharing, 700N 4th St, Richmond, VA 23219, United States
| | - David K. Klassen
- United Network for Organ Sharing, 700N 4th St, Richmond, VA 23219, United States
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Kostakis ID, Karydis N, Kassimatis T, Kessaris N, Loukopoulos I. The implications of donor-recipient size mismatch in renal transplantation. J Nephrol 2021; 34:2037-2051. [PMID: 34033003 DOI: 10.1007/s40620-021-01050-w] [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: 01/12/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Transplanting kidneys small for recipient's size results in inferior graft function. Body surface area (BSA) is related to kidney size. We used the BSA index (BSAi) (Donor BSA/Recipient BSA) to assess whether the renal graft size is sufficient for the recipient. METHODS We included 26,223 adult single kidney transplants (01/01/2007-31/12/2019) from the UK Transplant Registry. We divided renal transplants into groups: BSAi ≤ 0.75, 0.75 < BSA ≤ 1, 1 < BSAi ≤ 1.25, BSAi > 1.25. We compared delayed graft function rates, primary non-function rates and graft survival among them. (Reference category: BSAi ≤ 0.75). RESULTS Cases with BSAi ≤ 0.75 had the highest delayed graft function rates in living-donor renal transplants (11.1%) (0.75 < BSAi ≤ 1: OR = 0.59, 95% CI = 0.32-1.1, p = 0.095, 1 < BSAi ≤ 1.25: OR = 0.46, 95% CI = 0.23-0.89, p = 0.022, BSAi > 1.25: OR = 0.32, 95% CI = 0.13-0.77, p = 0.011) and in renal transplants from donors after brain death (26.2%) (0.75 < BSAi ≤ 1: OR = 0.72, 95% CI = 0.55-0.96, p = 0.024, 1 < BSAi ≤ 1.25: OR = 0.62, 95% CI = 0.47-0.83, p = 0.001, BSAi > 1.25: OR = 0.65, 95% CI = 0.47-0.9, p = 0.01). There were no significant differences in renal transplants from donors after circulatory death regarding delayed graft function rates (~ 40% in all groups). Graft survival was similar among BSAi groups in renal transplants from living donors and donors after brain death. Renal transplants from donors after circulatory death with BSAi ≤ 0.75 had the shortest graft survival (0.75 < BSAi ≤ 1: HR = 0.55, 95% CI = 0.41-0.74, p < 0.001, 1 < BSAi ≤ 1.25: HR = 0.48, 95% CI = 0.35-0.66, p < 0.001, BSAi > 1.25: HR = 0.45, 95% CI = 0.31-0.66, p < 0.001). Ten-year graft survival rate was 58.4% for renal transplants from donors after circulatory death with BSAi ≤ 0.75. CONCLUSIONS Delayed graft function risk is higher in renal transplants with BSAi ≤ 0.75 coming from living donors and donors after brain death. Graft survival is greatly reduced in renal transplants from donors after circulatory death with BSAi ≤ 0.75.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. .,Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK.
| | - Nikolaos Karydis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Theodoros Kassimatis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicos Kessaris
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Loukopoulos
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Arshad A, Hodson J, Chappelow I, Nath J, Sharif A. Kidney transplantation outcomes for adult recipients of pediatric donor kidneys. Pediatr Transplant 2021; 25:e13767. [PMID: 32536011 DOI: 10.1111/petr.13767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/23/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022]
Abstract
Despite a paucity of data assessing transplantation of deceased-donor pediatric donor kidneys into adult recipients, utilization of pediatric organs is declining in the UK, likely due to concerns that such organs may have inferior outcomes. However, we hypothesized that these concerns may be unfounded. As such, the aim of the study was to compare kidney transplant outcomes between adult recipients of pediatric and adult deceased-donor organs. Data were collected from the UK Transplant Registry for all adult (18+ years) deceased-donor single-kidney transplant recipients between January 2000 and January 2016. Univariable and multivariable analyses were undertaken, to compare a range of outcomes between recipients of kidneys from pediatric and adult donors. Transplants were stratified by the donor age (years) as follows: 0-16 (n = 666), 17-18 (n = 465), and 19-44 (n = 7378). Recipients of pediatric donor kidneys were observed to have improved long-term graft function, with a median creatinine at 1 year of 109 vs. 117 μmol/L for recipients of donors aged 0-16 vs. 19-44 years (P < .001). However, on multivariable analysis, this was not found to correspond to a significant difference in patient (P = .914) or graft survival (P = .190) between the donor age groups. Subgroup analysis within the younger donors found no significant differences in recipient outcomes between donors aged 0-6, 7-12, and 13-16 years. In this population cohort study, we identified excellent outcomes among adult recipients of pediatric donor kidneys. Pediatric donors are a valuable source of organs for adult recipients in an era where organ demand is rising.
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Affiliation(s)
- Adam Arshad
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - James Hodson
- Institute of Translational Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Imogen Chappelow
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jay Nath
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Nephrology and Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Donor-Recipient Matching to Optimize the Utility of High Kidney Donor Profile Index Kidneys. Transplant Proc 2020; 53:865-871. [PMID: 33358526 DOI: 10.1016/j.transproceed.2020.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/15/2020] [Accepted: 10/30/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND In December 2014, the Kidney Donor Profile Index (KDPI) was developed to give more precise information on donor kidney quality. Kidneys with KDPI scores ≥ 85 (K ≥ 85) have been reported to have inferior outcomes to kidneys with KDPI scores < 85. METHODS After the implementation of the new Kidney Allocation System, we developed a protocol to evaluate K ≥ 85 use. We analyzed the safety and efficacy of our institutional criteria and evaluated post-transplant outcomes. K ≥ 85 recipients were stratified based on their 1-year creatinine and estimated glomerular filtration rates to elucidate characteristics associated with serum creatinine < 1.7 mg/dL or estimated glomerular filtration rates ≤ 45 mL/min/1.73 m2. RESULTS From December 2014 to December 2019, 304 deceased donor kidney transplants were performed at Hartford Hospital; 58 (19%) were K ≥ 85 with an average KDPI of 91%. There were 4 graft losses; 2 were death censored. Prolonged cold ischemia time and black recipient race were associated with inferior recipient graft function at 1 year. CONCLUSIONS High KDPI kidney use requires a multifaceted evaluation that takes into account donor and recipient characteristics for an ideal match. We have identified several characteristics that may predict optimal post-transplant kidney function.
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Varley R, Piscoran O, Picton M, Moinuddin Z, van Dellen D, Augustine T. Kidney Transplantation From a 5-Day-Old Donor With a Single Functioning Kidney. EXP CLIN TRANSPLANT 2020; 18:732-736. [PMID: 33187465 DOI: 10.6002/ect.2020.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Kidney transplant restores renal function in eligible patients with end-stage renal failure who require renal replacement therapy. There remains a significant disparity between the demand and supply of suitable kidneys for transplant. In recent years, pediatric donors have formed an important area for expansion of the donor pool. However, neonatal donation (< 28 days) remains an underutilized resource. We describe a case of en bloc kidney transplant from a 5-day-old donor after circulatory death into an adult recipient. One kidney thrombosed almost immediately, leaving a single 4.5-cm, poorly functioning kidney. Eighteen months after transplant, the recipient has shown good function with the estimated glomerular filtration rate continuing to improve. This case demonstrates that a single neonatal kidney can grow and adapt to provide adequate renal function in an adult. This experience suggests that a single kidney from a neonate can sustain renal function in adults, and every effort should be made to maximize their use in transplant.
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Affiliation(s)
- Rebecca Varley
- From the Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Unitek Kingdom
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10
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Amesty MV, Fernandez C, Espinosa L, Rivas-Vila S, Lobato R, Monsalve S, Lopez-Pereira PC, Martinez-Urrutia MJ. Long-term outcomes of adult-size and size-matched kidney transplants in small pediatric recipients. J Pediatr Urol 2020; 16:481.e1-481.e8. [PMID: 32493667 DOI: 10.1016/j.jpurol.2020.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Adult-size kidneys are usually used for kidney transplantation in small pediatric recipients, but the influence of graft size in transplant outcome remains controversial. Our aim is to compare long-term transplant outcomes of using adult-size and size-matched kidneys in small pediatric recipients. MATERIALS AND METHODS Since 1999, 61 of 226 kidney transplants were achieved in recipients weighing <20 kg with 5 years of follow-up. Patients were analyzed according to the graft size received: (group-A) adult-size (n = 32), (group-B) size-matched (n = 29). Kidney size (KS), glomerular filtration rate (GFR) proteinuria and rejection were compared between groups at transplant time (T0), at one (T1), two (T2), five years (T5), and at the end of the follow-up (TF) (median follow-up 8.47(0-17) years). Graft and patient survival were determined and compared between groups. RESULTS Mean KS was significantly different between groups at T0 (A:11.3 ± 1.1 cm, B:8.8 ± 0.9 cm), (pT0<0.01), group-B evidenced graft growth, reaching similar sizes to group-A at T5 (A:11.7±1 cm, B:11.2±1 cm; pT5 = 0.13) and TF (A:12.2 ± 1.1 cm, B:12.4 ± 1.2 cm; pTF = 0.63), and group-A had a slight graft growth at TF (pT0-TF<0.01). Mean Schwartz-GFR at T0 was greater in group-A (138 ± 33 ml/min/1.73 m2) than group-B (109 ± 34 mL/min/1.73 m2) (pT0 = 0.01); during follow-up, it evidenced a reduction in group-A (T5:90 ± 27, TF:71 ± 24 mL/min/1.73 m2; pT0-T5<0.01; pT0-TF<0.01), meanwhile in group-B was stable until T5 (104 ± 33 mL/min/1.73 m2; pT0-T5 = 0.54), declining at TF (76 ± 31 mL/min/1.73 m2; pT0-TF<0.01); with no significant differences at T1, T2, T5, and TF between groups. Similar results were observed in mean Filler-GFR of both groups (Figure). Proteinuria and episodes of rejection were no significantly different between groups during the follow-up (p > 0.01; p = 0.23). Graft and patient survival at 5 and 10 years did not show significant differences (p = 0.45; p = 0.10). DISCUSSION Despite the initial kidney size difference between groups, we have demonstrated that they tended to the same size during the follow-up. Adult-size kidneys presented a slight size increase in the long-term, suggesting that they have some growth potential in small recipients, in contrast to previous literature. Mean GFR between groups showed no significant differences in the long-term, suggesting that optimal graft perfusion and function can be achieved despite the size of the graft. We have demonstrated that there were no significant differences in long-term graft and patient survival; this results were similar to the most recent literature about this topic and different from the 90-2000s decades literature. CONCLUSIONS Adult-size kidneys may be transplanted to small recipients (<20 kg) with comparable outcomes to size-matched kidneys, with no significant differences in long-term KS, GFR, proteinuria, rejection, graft or patient survival.
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Affiliation(s)
- Maria Virginia Amesty
- Department of Pediatric Urology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain.
| | - Carlota Fernandez
- Department of Pediatric Nephrology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Laura Espinosa
- Department of Pediatric Nephrology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Susana Rivas-Vila
- Department of Pediatric Urology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Roberto Lobato
- Department of Pediatric Urology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Shirley Monsalve
- Department of Pediatric Urology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Pedro Carlos Lopez-Pereira
- Department of Pediatric Urology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Maria Jose Martinez-Urrutia
- Department of Pediatric Urology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
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Kanzelmeyer NK, Lerch C, Ahlenstiel-Grunow T, Bräsen JH, Haffner D, Pape L. The role of protocol biopsies after pediatric kidney transplantation. Medicine (Baltimore) 2020; 99:e20522. [PMID: 32502003 PMCID: PMC7306334 DOI: 10.1097/md.0000000000020522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Data on protocol biopsies (PBs) after pediatric kidney transplantation are rare.We evaluated 6-month post-transplantation renal function in 86 children after PB as observational study. Patients were divided into 3 groups:Glomerular filtration rate (GFR) and delta GFR were determined.PBs 6 months post-kidney transplantation did not influence the clinical course in stable pediatric patients and are therefore of questionable value. Decreased kidney function may however be stabilized by therapeutic intervention according to results of PB.
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Affiliation(s)
| | | | | | - Jan H. Bräsen
- Department of Pathology, Hannover Medical School, Hannover, Germany
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Sharif A. Should donor body mass index influence kidney utilization by transplant centers? Transpl Int 2019; 33:56-58. [PMID: 31554013 DOI: 10.1111/tri.13529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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