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Kidney transplantation from elderly donors (> 70 years): a systematic review. World J Urol 2023; 41:695-707. [PMID: 36907943 DOI: 10.1007/s00345-023-04311-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/22/2023] [Indexed: 03/14/2023] Open
Abstract
PURPOSE The incidence of kidney transplants from elderly donors over 70 years of age has increased significantly over the past 10 years to reach 20% of available kidney graft in some European countries. However, there is little data available on the outcomes of transplants from these donors. We performed a systematic review to evaluate the outcomes of transplantation from donors over 70 years of age. METHODS A systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses. Medline, Embase, and Cochrane databases were searched to identify all studies reporting outcomes on kidney transplants from donors over 70 years. Due to the heterogeneity of the studies, a meta-analysis could not be performed. RESULTS A total of 29,765 patients in 27 studies were included. The mean donors age was 74.79 years, and proportion of kidney graft from women was 53.54%. The estimated 1- and 5-year kidney death-censored graft survivals from donors > 70 years old were, respectively, 85.95 and 80.27%, and the patient survivals were 90.88 and 71.29%. The occurrence of delayed graft function was 41.75%, and primary non-function was 4.67%. Estimated graft function at 1 and 5 years was 36 and 38 mL/min/1.73 m2. Paucity data were available on post-operative complications. CONCLUSIONS Elderly donors appear to be a reliable source of grafts. However, these transplants are associated with a high rate of delayed graft function without repercussion on long-term graft survival. Allocation strategy to elderly recipients is the main factor of decreased recipient survival.
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Koch M, Zecher D, Lopau K, Weinmann-Menke J, Schulze A, Nashan B, Wenzel U, Banas B, Zeier M, Thaiss F, Sommerer C. Human Leucocyte Antigen-Matching Can Improve Long Term Outcome of Renal Allografts from Donors Older Than 75 Years. Transplant Proc 2023; 55:309-316. [PMID: 36801175 DOI: 10.1016/j.transproceed.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/21/2022] [Accepted: 12/09/2022] [Indexed: 02/21/2023]
Abstract
BACKGROUND Renal transplantation is the therapy of choice for kidney failure. The Eurotransplant Senior Program (ESP) has been established to allocate kidneys ≥65 years to recipients of the same age group considered a regional allocation with short cold ischemia (CIT) but not human-leukocyte-antigen (HLA)-matching. The acceptance of organs aged ≥75 years is also still controversial within the ESP. METHODS In a multicenter approach, 179 kidney grafts ≥75 years (mean donor age 78 years) that were transplanted in 174 patients in 5 German transplant centers were analyzed. The primary focus of the analysis was long-term outcome of the grafts and the impact of CIT, HLA matching, and recipient related risk factors. RESULTS The mean graft survival was 59 months (median 67 months) with a mean donor age of 78.3 ± 2.9 years. Grafts with 0 to 3 HLA-mismatches had a significantly better overall graft survival compared to grafts with ≥4 mismatches (69 months vs 54 months; P = .008). The mean CIT was short (11.9 ± 5.3 hours) and had no impact on graft survival. CONCLUSION Recipients receiving a kidney graft from donors aged ≥75 years can benefit from nearly 5 years of survival with a functioning graft. Even minimal HLA matching may improve long term allograft survival.
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Affiliation(s)
- Martina Koch
- General-, Visceral- and Transplantation Surgery, University Medical Center, Mainz, Germany; Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Germany.
| | - Daniel Zecher
- Department of Nephrology, University Medical Center Regensburg, Germany
| | - Kai Lopau
- Department of Nephrology, University Medical Center Würzburg, Germany
| | - Julia Weinmann-Menke
- Department of Medicine, Section Nephrology; University Medical Center, Mainz, Germany
| | - Alicia Schulze
- Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Center, Mainz, Germany
| | - Björn Nashan
- Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Germany; Clinic of Hepato-pancreatico-biliary Surgery and The Transplantation Center First Affiliated Hospital, School of Life Sciences and Medical Center University of Sciences & Technology of China, Hefei, Anhui, China
| | - Ulrich Wenzel
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernhard Banas
- Department of Nephrology, University Medical Center Regensburg, Germany
| | - Martin Zeier
- Nephrology Unit, Renal Center Heidelberg, University Medical Center Heidelberg, Germany
| | - Friedrich Thaiss
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Sommerer
- Nephrology Unit, Renal Center Heidelberg, University Medical Center Heidelberg, Germany
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Clinical Phenotypes of Dual Kidney Transplant Recipients in the United States as Identified through Machine Learning Consensus Clustering. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121831. [PMID: 36557033 PMCID: PMC9783488 DOI: 10.3390/medicina58121831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/03/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Background and Objectives: Our study aimed to cluster dual kidney transplant recipients using an unsupervised machine learning approach to characterize donors and recipients better and to compare the survival outcomes across these various clusters. Materials and Methods: We performed consensus cluster analysis based on recipient-, donor-, and transplant-related characteristics in 2821 dual kidney transplant recipients from 2010 to 2019 in the OPTN/UNOS database. We determined the important characteristics of each assigned cluster and compared the post-transplant outcomes between clusters. Results: Two clinically distinct clusters were identified by consensus cluster analysis. Cluster 1 patients was characterized by younger patients (mean recipient age 49 ± 13 years) who received dual kidney transplant from pediatric (mean donor age 3 ± 8 years) non-expanded criteria deceased donor (100% non-ECD). In contrast, Cluster 2 patients were characterized by older patients (mean recipient age 63 ± 9 years) who received dual kidney transplant from adult (mean donor age 59 ± 11 years) donor with high kidney donor profile index (KDPI) score (59% had KDPI ≥ 85). Cluster 1 had higher patient survival (98.0% vs. 94.6% at 1 year, and 92.1% vs. 76.3% at 5 years), and lower acute rejection (4.2% vs. 6.1% within 1 year), when compared to cluster 2. Death-censored graft survival was comparable between two groups (93.5% vs. 94.9% at 1 year, and 89.2% vs. 84.8% at 5 years). Conclusions: In summary, DKT in the United States remains uncommon. Two clusters, based on specific recipient and donor characteristics, were identified through an unsupervised machine learning approach. Despite varying differences in donor and recipient age between the two clusters, death-censored graft survival was excellent and comparable. Broader utilization of DKT from high KDPI kidneys and pediatric en bloc kidneys should be encouraged to better address the ongoing organ shortage.
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Taber-Hight E, Paramesh A, Neidlinger N, Lebovitz DJ, Souter M, Taber T. The Impact of Organ Procurement Injury on Transplant Organ Availability. Transplant Proc 2022; 54:2075-2081. [DOI: 10.1016/j.transproceed.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/10/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022]
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5
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Cuadrado-Payán E, Montagud-Marrahi E, Casals-Urquiza J, del Risco-Zevallos J, Rodríguez-Espinosa D, Cacho J, Arana C, Cucchiari D, Ventura-Aguiar P, Revuelta I, Piñeiro GJ, Esforzado N, Cofan F, Bañon-Maneus E, Campistol JM, Oppenheimer F, Torregrosa JV, Diekmann F. Outcomes in older kidney recipients from older donors: A propensity score analysis. FRONTIERS IN NEPHROLOGY 2022; 2:1034182. [PMID: 37675023 PMCID: PMC10479569 DOI: 10.3389/fneph.2022.1034182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/06/2022] [Indexed: 09/08/2023]
Abstract
Background The age of patients referred for kidney transplantation has increased progressively. However, the precise influence of age on transplant outcomes is controversial. Methods Etrospective study in which graft and recipient survival were assessed in a cohort of ≥75 years old kidney recipients and compared with a contemporary younger one aged 60-65 years through a propensity score analysis. Results We included 106 recipients between 60-65 and 57 patients of ≥75 years old with a median follow-up of 31 [13-54] months. Unadjusted one- and five-year recipient survival did not significantly differ between the older (91% and 74%) and the younger group (95% and 82%, P=0.06). In the IPTW weighted Cox regression analysis, recipient age was not associated with an increased risk of death (HR 1.88 95%CI [0.81-4.37], P=0.14). Unadjusted one- and five-year death-censored graft survival did not significantly differ between both groups (96% and 83% for the older and 99% and 89% for the younger group, respectively, P=0.08). After IPTW weighted Cox Regression analysis, recipient age ≥75 years was no associated with an increased risk of graft loss (HR 1.95, 95%CI [0.65-5.82], P=0.23). Conclusions These results suggest that recipient age should not be considered itself as an absolute contraindication for kidney transplant.
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Affiliation(s)
- Elena Cuadrado-Payán
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Enrique Montagud-Marrahi
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Joaquim Casals-Urquiza
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
| | | | - Diana Rodríguez-Espinosa
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
| | - Judit Cacho
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
| | - Carolt Arana
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - David Cucchiari
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Ignacio Revuelta
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Gaston J. Piñeiro
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Nuria Esforzado
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
| | - Frederic Cofan
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
| | - Elisenda Bañon-Maneus
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Josep M. Campistol
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Federico Oppenheimer
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Josep-Vicens Torregrosa
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
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Chang WB, Shin YH, Park HS, Kim DH, Lee T. The use of polytetrafluoroethylene graft for damaged renal artery in ABO-incompatible living donor kidney transplantation: a case report. KOREAN JOURNAL OF TRANSPLANTATION 2022; 36:67-72. [PMID: 35769426 PMCID: PMC9235532 DOI: 10.4285/kjt.21.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022] Open
Abstract
Short donor renal vessels during donor nephrectomy represent a technical challenge. The allograft of vessels from deceased donors can be an option for reconstruction; however, cryopreserved vessels are not routinely prepared for living donor kidney transplantation (LDKT). We report a reconstruction of the damaged short renal artery (RA) in LDKT using a polytetrafluoroethylene (PTFE) graft. A 45-year-old male patient underwent ABO-incompatible LDKT from his wife. After donor nephrectomy, we detected a hematoma surrounding the proximal RA of the allograft. The injured segment of the RA was transected, and the short RA was connected to the right external artery of the recipient; however, the blood flow was interrupted by the graft location. Once the arterial anastomosis was removed, the graft was flushed with cold saline, and a PTFE graft was used for the reconstruction of the short RA. Immediate blood flow to the renal graft was excellent without sign of parenchymal infarction until fascial closure. Renal graft Doppler on postoperative day 7 and 3 months showed good blood flow. In this patient, the use of PTFE graft presented no additional morbidity to the kidney transplantation, and no postoperative complications related to its use were noted.
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Affiliation(s)
- Won-Bae Chang
- Department of Surgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Young-Heun Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyung Sub Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dong-Hwan Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Stratta RJ, Harriman D, Gurram V, Gurung K, Sharda B. The use of marginal kidneys in dual kidney transplantation to expand kidney graft utilization. Curr Opin Organ Transplant 2022; 27:75-85. [PMID: 34939967 DOI: 10.1097/mot.0000000000000946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to chronicle the history of dual kidney transplantation (DKT) and identify opportunities to improve utilization of marginal deceased donor (MDD) kidneys through DKT. RECENT FINDINGS The practice of DKT from adult MDDs dates back to the mid-1990s, at which time the primary indication was projected insufficient nephron mass from older donors. Multiple subsequent studies of short- and long-term success have been reported focusing on three major aspects: Identifying appropriate selection criteria/scoring systems based on pre- and postdonation factors; refining technical aspects; and analyzing longer-term outcomes. The number of adult DKTs performed in the United States has declined in the past decade and only about 60 are performed annually. For adult deceased donor kidneys meeting double allocation criteria, >60% are ultimately not transplanted. MDDs with limited renal functional capacity represent a large proportion of potential kidneys doomed to either discard or nonrecovery. SUMMARY DKT may reduce organ discard and optimize the use of kidneys from MDDs. New and innovative technologies targeting ex vivo organ assessment, repair, and regeneration may have a major impact on the decision whether or not to use recovered kidneys for single or DKT.
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Affiliation(s)
- Robert J Stratta
- The Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David Harriman
- The Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Venkat Gurram
- The Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Komal Gurung
- The Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Berjesh Sharda
- The Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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8
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Stratta RJ, Harriman D, Gurram V, Gurung K, Sharda B. Dual kidney transplants from adult marginal donors: Review and perspective. Clin Transplant 2021; 36:e14566. [PMID: 34936135 DOI: 10.1111/ctr.14566] [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: 08/27/2021] [Revised: 10/08/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
The practice of dual kidney transplantation (DKT) from adult marginal deceased donors (MDDs) dates back to the mid-1990s with initial pioneering experiences reported by the Stanford and Maryland groups, at which time the primary indication was estimated insufficient nephron mass from older donors. Multiple subsequent studies of short and long-term success have been reported focusing on three major aspects of DKT: Identifying appropriate selection criteria and developing scoring systems based on pre- and post-donation factors; refining technical aspects; and analyzing mid-term outcomes. The number of adult DKTs performed in the United States has declined in the past decade and only about 60 are performed annually. For adult deceased donor kidneys meeting double allocation criteria, >60% are ultimately not transplanted. Deceased donors with limited renal functional capacity represent a large proportion of potential kidneys doomed to either discard or non-recovery. However, DKT may reduce organ discard and optimize the use of kidneys from MDDs. In an attempt to promote utilization of MDD kidneys, the United Network for Organ Sharing introduced new allocation guidelines pursuant to DKT in 2019. The purpose of this review is to chronicle the history of DKT and identify opportunities to improve utilization of MDD kidneys through DKT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Robert J Stratta
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, One Medical Center Blvd., Winston-Salem, NC, 27157, United States
| | - David Harriman
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, V5Z1M9, Canada
| | - Venkat Gurram
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, One Medical Center Blvd., Winston-Salem, NC, 27157, United States
| | - Komal Gurung
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, One Medical Center Blvd., Winston-Salem, NC, 27157, United States
| | - Berjesh Sharda
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, One Medical Center Blvd., Winston-Salem, NC, 27157, United States
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Cohen C, Le Goff O, Soysouvanh F, Vasseur F, Tanou M, Nguyen C, Amrouche L, Le Guen J, Saltel-Fulero O, Meunier T, Nguyen-Khoa T, Rabant M, Nochy D, Legendre C, Friedlander G, Childs BG, Baker DJ, Knebelmann B, Anglicheau D, Milliat F, Terzi F. Glomerular endothelial cell senescence drives age-related kidney disease through PAI-1. EMBO Mol Med 2021; 13:e14146. [PMID: 34725920 PMCID: PMC8573606 DOI: 10.15252/emmm.202114146] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
The mechanisms underlying the development of glomerular lesions during aging are largely unknown. It has been suggested that senescence might play a role, but the pathophysiological link between senescence and lesion development remains unexplained. Here, we uncovered an unexpected role for glomerular endothelial cells during aging. In fact, we discovered a detrimental cross-talk between senescent endothelial cells and podocytes, through PAI-1. In vivo, selective inactivation of PAI-1 in endothelial cells protected glomeruli from lesion development and podocyte loss in aged mice. In vitro, blocking PAI-1 in supernatants from senescent endothelial cells prevented podocyte apoptosis. Consistently, depletion of senescent cells prevented podocyte loss in old p16 INK-ATTAC transgenic mice. Importantly, these experimental findings are relevant to humans. We showed that glomerular PAI-1 expression was predictive of poor outcomes in transplanted kidneys from elderly donors. In addition, we observed that in elderly patients, urinary PAI-1 was associated with age-related chronic kidney disease. Altogether, these results uncover a novel mechanism of kidney disease and identify PAI-1 as a promising biomarker of kidney dysfunction in allografts from elderly donors.
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Affiliation(s)
- Camille Cohen
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
| | - Océane Le Goff
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
| | - Frédéric Soysouvanh
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), Laboratoire Radiobiologie des Expositions Médicale, Fontenay-aux-Roses, France
| | - Florence Vasseur
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
| | - Marine Tanou
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
| | - Clément Nguyen
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
| | - Lucile Amrouche
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
- Service de Néphrologie-Transplantation, Hôpital Necker Enfants Malades, AP-HP centre, Université de Paris, Paris, France
| | - Julien Le Guen
- Service de Gériatrie, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Oriana Saltel-Fulero
- Service de Gériatrie, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Tanguy Meunier
- Service de Gériatrie, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Thao Nguyen-Khoa
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
- Service de Biochimie, Hôpital Necker Enfants Malades, AP-HP Centre, Université de Paris, Paris, France
| | - Marion Rabant
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
- Service d'Anatomo-Pathologie, AP-HP, Hôpital Necker Enfants Malades, AP-HP Centre, Université de Paris, Paris, France
| | - Dominique Nochy
- Service d'Anatomo-Pathologie, Hôpital Européen George Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Christophe Legendre
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
- Service de Néphrologie-Transplantation, Hôpital Necker Enfants Malades, AP-HP centre, Université de Paris, Paris, France
| | - Gérard Friedlander
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
| | - Bennett G Childs
- Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Daren J Baker
- Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, MN, USA
- Robert and Arlene Kogod Center on Aging, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Bertrand Knebelmann
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
- Service de Néphrologie-Transplantation, Hôpital Necker Enfants Malades, AP-HP centre, Université de Paris, Paris, France
| | - Dany Anglicheau
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
- Service de Néphrologie-Transplantation, Hôpital Necker Enfants Malades, AP-HP centre, Université de Paris, Paris, France
| | - Fabien Milliat
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), Laboratoire Radiobiologie des Expositions Médicale, Fontenay-aux-Roses, France
| | - Fabiola Terzi
- Université de Paris, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Département "Croissance et Signalisation", Paris, France
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10
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Liu L, Cheng K, Huang J. Effect of Long Cold Ischemia Time of Kidneys from Aged Donors on Prognosis of Kidney Transplantation. Ann Transplant 2021; 26:e928735. [PMID: 34663778 PMCID: PMC8540027 DOI: 10.12659/aot.928735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
With the increasing incidence of end-stage renal disease (ESRD), patients' life span and life quality are significantly reduced. Kidney transplantation has gradually become the ideal method for treating ESRD, and the shortage of organ sources has become the main problem. In recent years, China has successfully realized the transformation of organ sources. Voluntary donation after the death of citizens has increased year by year, and the number of kidney transplantations has increased, which alleviates the organ shortage to a certain extent, but compared with the past, the increasing proportion of aged donors has also become an inevitable global problem. At the same time, due to the sudden and widespread distribution of voluntary donation, most donor kidneys have the problem of longer cold ischemic time (CIT). The probability of adverse events, such as delayed renal function recovery after transplantation, was also significantly increased. At present, there is little research on the effect of donor's aging and long CIT on the prognosis of renal transplantation. This paper reviews the literature in recent years and explore this problem from 2 aspects: the elderly donor and the long CIT.
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Affiliation(s)
- Lian Liu
- Center for Organ Transplantation, 3rd Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, 3rd Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan, China (mainland)
| | - Ke Cheng
- Center for Organ Transplantation, 3rd Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, 3rd Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Jufang Huang
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan, China (mainland)
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11
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Yazdani B, Marinez J, Krüger B, Kälsch AI, Jung M, Chen G, Leipe J, Benck U, Schnülle P, Nuhn P, Keese M, Schwenke K, Krämer BK. Patient and Graft Survival After Dual Kidney Transplantation With Marginal Donors in Comparison to Matched Control Groups. Transplant Proc 2021; 53:2180-2187. [PMID: 34429190 DOI: 10.1016/j.transproceed.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/30/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postmortal organ donor rates remain low in Germany, whereas donor age has been increasing considerably in the last decades. As a consequence of low donation rates older and more marginal donor kidneys are accepted for transplantation. However, procured kidneys from very old a/o marginal donors may be considered as not suitable for transplantation as a single organ and subsequently be discarded. However, dual transplantation of both kidneys from such donors may provide an opportunity to nevertheless use these organs for renal transplantation, thereby providing the twofold nephron mass as a single kidney transplantation. METHODS We compared in this retrospective analysis the outcome of 10 recipients of a dual kidney transplantation (DKT) with 40 matched recipients of a single kidney transplantation (SKT). Recipients were matched for donor and recipient age (ie, a maximum age difference of ±10 years in a ratio of 1:4 for DKT vs SKT recipients). In addition, a second SKT control group of 10 SKT recipients being transplanted immediately before each DKT recipient with a kidney from a donor aged ≥65 years was used for comparison. All renal transplant recipients were observed for up to 3 years or until July 31, 2020. RESULTS Mean donor and recipient age was 77.2 ± 4.6/75.1 ± 6.6/82.1 ± 7.9 and 66.4 ± 5.8/66.1 ± 6.0/64.8 ± 8.4 for SKT group 1/SKT group 2/DKT, respectively. Procurement serum creatinine concentrations were significantly higher in the DKT group in comparison to the SKT control group 1 (P = .019) as was the rate of transplant artery atherosclerosis (P = .021). Furthermore, Kidney Donor Profile Index, and Kidney Donor Risk Index were significantly higher (P = .0138/P = .064, and P < .001/P = .038) in the DKT group than in SKT group 1 and 2. Rates of acute rejection and delayed graft function were not significantly different between groups, though biopsy-proven acute rejection was numerically higher in the SKT groups. Patient survival and overall and death-censored graft survival rates were also not significantly different between groups, although they tended to be higher after DKT. CONCLUSIONS DKT provides an opportunity to successfully use postmortal kidneys even from donors aged >80 years and a Kidney Donor Profile Index ≥95% for renal transplantation. DKT may thereby increase the available pool of donors to better serve patients with end-stage renal disease on the waiting list.
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Affiliation(s)
- Babak Yazdani
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; European Center of Angioscience Ecas, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Julian Marinez
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Bernd Krüger
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Anna-Isabelle Kälsch
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Matthias Jung
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Gangyi Chen
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; First Affiliated Hospital of the Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jan Leipe
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Urs Benck
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Renal Center Villingen-Schwenningen, Germany
| | - Peter Schnülle
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Renal Center Weinheim, Germany
| | - Philipp Nuhn
- Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Department of Urology and Urosurgery, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Michael Keese
- Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; European Center of Angioscience Ecas, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Department of Vascular and Transplant Surgery, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Kay Schwenke
- Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; European Center of Angioscience Ecas, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Department of Vascular and Transplant Surgery, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Bernhard K Krämer
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Transplant Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; European Center of Angioscience Ecas, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Mannheim Institute for Innate Immunoscience, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.
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12
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Carrara C, Ruggenenti P, Remuzzi G. Redefining the Role of Donor Biopsies in the Process of Kidney Graft Assessment. Nephron Clin Pract 2021; 145:728-731. [PMID: 34293750 DOI: 10.1159/000517730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/07/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Camillo Carrara
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,Unit of Nephrology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Piero Ruggenenti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,Unit of Nephrology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
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13
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Impaired renal function before kidney procurement has a deleterious impact on allograft survival in very old deceased kidney donors. Sci Rep 2021; 11:12226. [PMID: 34108573 PMCID: PMC8190122 DOI: 10.1038/s41598-021-91843-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
As the use of elderly kidney donors for transplantation is increasing with time, there is a need to understand which factors impact on their prognosis. No data exist on the impact of an impaired renal function (IRF) in such population. 116 kidney recipients from deceased kidney donors over 70 years were included from 2005 to 2015 in a single-center retrospective study. IRF before organ procurement was defined as a serum creatinine above 1.0 mg/dl or a transient episode of oligo-anuria. Mean ages for donors and recipients were respectively 74.8 ± 3.5 and 66.7 ± 8.0. Graft survival censored for death at 5 years was of 77%. Using a multivariate analysis by Cox model, the only predictor of graft loss present in the donor was IRF before organ procurement (HR 4.2 CI95[1.8–9.7]). IRF was also associated with significant lower estimated glomerular filtration rates up to 1 year post-transplantation. By contrast, KDPI score (median of 98 [96–100]), was not associated with the risk of graft failure. Then, IRF before kidney procurement may define a risk subgroup among very-old deceased kidney donors, in whom pre-implantatory biopsies, dual kidney transplantation or calcineurin inhibitor-free immunosuppressive regimen could help to improve outcomes.
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14
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Senanayake S, Graves N, Healy H, Baboolal K, Barnett A, Kularatna S. Time-to-event analysis in economic evaluations: a comparison of modelling methods to assess the cost-effectiveness of transplanting a marginal quality kidney. HEALTH ECONOMICS REVIEW 2021; 11:13. [PMID: 33856573 PMCID: PMC8051030 DOI: 10.1186/s13561-021-00312-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Economic-evaluations using decision analytic models such as Markov-models (MM), and discrete-event-simulations (DES) are high value adds in allocating resources. The choice of modelling method is critical because an inappropriate model yields results that could lead to flawed decision making. The aim of this study was to compare cost-effectiveness when MM and DES were used to model results of transplanting a lower-quality kidney versus remaining waitlisted for a kidney. METHODS Cost-effectiveness was assessed using MM and DES. We used parametric survival models to estimate the time-dependent transition probabilities of MM and distribution of time-to-event in DES. MMs were simulated in 12 and 6 monthly cycles, out to five and 20-year time horizon. RESULTS DES model output had a close fit to the actual data. Irrespective of the modelling method, the cycle length of MM or the time horizon, transplanting a low-quality kidney as compared to remaining waitlisted was the dominant strategy. However, there were discrepancies in costs, effectiveness and net monetary benefit (NMB) among different modelling methods. The incremental NMB of the MM in the 6-months cycle lengths was a closer fit to the incremental NMB of the DES. The gap in the fit of the two cycle lengths to DES output reduced as the time horizon increased. CONCLUSION Different modelling methods were unlikely to influence the decision to accept a lower quality kidney transplant or remain waitlisted on dialysis. Both models produced similar results when time-dependant transition probabilities are used, most notable with shorter cycle lengths and longer time-horizons.
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Affiliation(s)
- Sameera Senanayake
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia.
| | - Nicholas Graves
- Duke-NUS Medical School, 8 College road, Singapore, Singapore
| | - Helen Healy
- Royal Brisbane Hospital for Women, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Keshwar Baboolal
- Royal Brisbane Hospital for Women, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Adrian Barnett
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
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15
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Collini A, Miccoli S, Piccioni S, Benigni R, Ruggieri G, Carmellini M. Explant of one graft due to technical complications in dual kidney transplants: analysis of the long-term function of the remaining kidney. J Nephrol 2021; 34:2127-2130. [PMID: 33704658 DOI: 10.1007/s40620-021-01006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Andrea Collini
- Renal Transplant Center, Siena University Hospital, Siena, Italy.
| | - Simone Miccoli
- Renal Transplant Center, Siena University Hospital, Siena, Italy
| | | | - Roberto Benigni
- Renal Transplant Center, Siena University Hospital, Siena, Italy
| | | | - Mario Carmellini
- Renal Transplant Center, Siena University Hospital, Siena, Italy
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16
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Kuhn C, Lang BM, Lörcher S, Karolin A, Binet I, Beldi G, Golshayan D, Hadaya K, Mueller TF, Schaub S, Immer F, Stampf S, Koller M, Sidler D. Outcome of kidney transplantation from very senior donors in Switzerland - a national cohort study. Transpl Int 2021; 34:689-699. [PMID: 33529392 DOI: 10.1111/tri.13836] [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: 11/20/2020] [Revised: 12/18/2020] [Accepted: 01/29/2021] [Indexed: 11/29/2022]
Abstract
Kidney transplantation from older and marginal donors is effective to confront organ shortage. However, limitations after transplantation of kidneys from very marginal kidney donors remain unclear. We compared patient and graft outcome, achieved allograft function and quality of life of renal transplantations from Very Senior Donors (VSD, defined as donors aged 70 years and older) with Senior Donors (SD, aged 60-70 years) and Regular Donors (RD, aged younger than 60 years) in Switzerland. We evaluated the outcome of 1554 adult recipients of deceased donor kidney transplantations from 05/2008 to 12/2019; median follow-up was 4.7 years. Failure-free survival (freedom from graft loss or death), glomerular filtration rate (eGFR), and quality of life at 12 months were analyzed for RD (reference group, n = 940), SD (n = 404), and VSD (n = 210). Failure-free survival decreased with increasing donor age, mainly attributable to premature graft loss. Still, overall 5-year failure-free survival reached 83.1%, 81.0%, and 64.0% in the RD, SD, and VSD subgroups, respectively. eGFR 12 months post-transplantation was significantly higher in RD compared with SD and VSD. The acceptance rate of donor candidates for kidney TPL was 78% for the entire cohort (87% for RD, 79% for SD, and 56% for VSD). Deceased donor kidney transplantation from donors aged 70 years or older is associated with an inferior, yet acceptable failure-free outcome, with sustained quality of life.
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Affiliation(s)
- Christian Kuhn
- Klinik für Nephrologie und Hypertonie, Inselspital, Bern, Switzerland
| | - Brian M Lang
- Klinik für Transplantationsimmunologie und Nephrologie, Universitätsspital Basel, Basel, Switzerland.,Swiss Transplant Cohort Study (STCS), Basel, Switzerland
| | - Sylvia Lörcher
- Klinik für Nephrologie und Hypertonie, Inselspital, Bern, Switzerland
| | - Andrea Karolin
- Klinik für Nephrologie und Hypertonie, Inselspital, Bern, Switzerland
| | - Isabelle Binet
- Klinik für Nephrologie und Transplantationsmedizin, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Guido Beldi
- Klinik für Viszerale Chirurgie und Medizin, Inselspital, Bern, Switzerland
| | - Délaviz Golshayan
- Centre de Transplantation d'organes et Service de Néphrologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Karine Hadaya
- Service de Néphrologie et Hypertension, Hôpitaux Universitaires Genève, Genève, Switzerland
| | - Thomas F Mueller
- Klinik für Nephrologie, Universitätsspital Zürich, Zürich, Switzerland
| | - Stefan Schaub
- Klinik für Transplantationsimmunologie und Nephrologie, Universitätsspital Basel, Basel, Switzerland
| | | | - Susanne Stampf
- Klinik für Transplantationsimmunologie und Nephrologie, Universitätsspital Basel, Basel, Switzerland.,Swiss Transplant Cohort Study (STCS), Basel, Switzerland
| | - Michael Koller
- Klinik für Transplantationsimmunologie und Nephrologie, Universitätsspital Basel, Basel, Switzerland
| | - Daniel Sidler
- Klinik für Nephrologie und Hypertonie, Inselspital, Bern, Switzerland
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17
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Carrara C, Cravedi P, Perna A, Peraro F, Villa A, Carrara F, Cortinovis M, Gotti E, Plati AR, Amaduzzi A, Rota G, Lacanna F, Rossini G, Abelli M, Remuzzi G, Ruggenenti P. Preimplantation Histological Score Associates with 6-Month GFR in Recipients of Perfused, Older Kidney Grafts: Results from a Pilot Study. Nephron Clin Pract 2021; 145:137-149. [PMID: 33486477 DOI: 10.1159/000512341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Biopsy-guided selection of older kidneys safely expands the organ pool, and pretransplant perfusion improves the preservation of these fragile organs. Herein, we studied morphofunctional variables associated with graft outcomes in perfused, histologically evaluated older kidneys. METHODS This single-center prospective cohort pilot study evaluated the relationships between preimplantation histologic scores and renal perfusion parameters during hypothermic, pulsatile, machine perfusion (MP) and assessed whether these morphofunctional parameters associated with GFR (iohexol plasma clearance) at 6 months after transplantation in 20 consecutive consenting recipients of a biopsy-guided single or dual kidney transplant from >60-year-old deceased donors. RESULTS The donor and recipient age was 70.4 ± 6.5 and 63.6 ± 7.9 years (p = 0.005), respectively. The kidney donor profile index (KDPI) was 93.3 ± 8.4% (>80% in 19 cases), histologic score 4.4 ± 1.4, and median (IQR) cold ischemia time 19.8 (17.8-22.8 h; >24 h in 5 cases). The 6-month GFR was 41.2 (34.9-55.7) mL/min. Vascular resistances positively correlated with global histologic score (p = 0.018) at MP start and then decreased from 0.88 ± 0.43 to 0.36 ± 0.13 mm Hg/mL/min (p < 0.001) in parallel with a three-fold renal flow increase from 24.0 ± 14.7 to 74.7 ± 31.8 mL/min (p < 0.001). Consistently, vascular resistance reductions positively correlated with global histologic score (p = 0.009, r = -0.429). Unlike KDPI or vascular resistances, histologic score was independently associated with 6-month GFR (beta standardized coefficient: -0.894, p = 0.005). CONCLUSIONS MP safely improves graft perfusion, particularly in kidneys with severe histologic changes that would not be considered for transplantation because of high KDPI. The preimplantation histologic score associates with the functional recovery of older kidneys even in the context of a standardized program of pulsatile perfusion.
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Affiliation(s)
- Camillo Carrara
- Department of Renal Medicine, Clinical Research Centre for Rare Diseases "Aldo e Cele Daccò": Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Cravedi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Translational Transplant Research Center, New York, New York, USA
| | - Annalisa Perna
- Department of Renal Medicine, Clinical Research Centre for Rare Diseases "Aldo e Cele Daccò": Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Francesco Peraro
- Department of Renal Medicine, Clinical Research Centre for Rare Diseases "Aldo e Cele Daccò": Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Alessandro Villa
- Department of Renal Medicine, Clinical Research Centre for Rare Diseases "Aldo e Cele Daccò": Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Fabiola Carrara
- Department of Renal Medicine, Clinical Research Centre for Rare Diseases "Aldo e Cele Daccò": Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Monica Cortinovis
- Department of Renal Medicine, Clinical Research Centre for Rare Diseases "Aldo e Cele Daccò": Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Eliana Gotti
- Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Rita Plati
- Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Annalisa Amaduzzi
- Department of Organ Failure and Transplantation, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Giovanni Rota
- Department of Organ Failure and Transplantation, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Lacanna
- Department of Organ Failure and Transplantation, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Rossini
- Organ and Tissue Transplant Immunology Unit, Foundation IRCCS "Ca' Granda Ospedale Maggiore Policlinico", Milan, Italy
| | - Massimo Abelli
- Kidney Transplant Unit, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Remuzzi
- Department of Renal Medicine, Clinical Research Centre for Rare Diseases "Aldo e Cele Daccò": Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy,
| | - Piero Ruggenenti
- Department of Renal Medicine, Clinical Research Centre for Rare Diseases "Aldo e Cele Daccò": Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
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18
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Trevisani F, Di Marco F, Capitanio U, Dell'Antonio G, Cinque A, Larcher A, Lucianò R, Bettiga A, Vago R, Briganti A, Salonia A, Montorsi F, Porrini E. Renal histology across the stages of chronic kidney disease. J Nephrol 2021; 34:699-707. [PMID: 33394348 DOI: 10.1007/s40620-020-00905-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The chronic kidney disease (CKD) classification represents a simple tool to evaluate kidney disease. However, it is not based on kidney histology and this might limit the correlation between renal function and histological damage. The aim of this study was to examine the presence and magnitude of the discordance between CKD classification and kidney histology. MATERIALS AND METHODS We retrospectively analyzed kidney parenchyma histology in a cohort of 200 patients who underwent radical nephrectomy for a kidney mass to observe its correlation with CKD classification. Kidney tissue of the unaffected part of the removed kidney was analyzed and classified with a chronicity score as described by Sethi et al. Then, all patients were classified according to the respective CKD stage using different equations: CKD-EPI, MDRD, FAS and MCQ. RESULTS Median age was 67 (57-75). Diabetes, hypertension and overweight were observed in 23%, 60% and 61%, respectively. The CKD-EPI equation stratified 30.5% (n = 61) of the subjects into CKD stage 1, 41.5% (n = 83) into CKD stage 2, 25.5% into CKD stage 3 (n = 51) and 2.5% into CKD stage 4-5 (n = 5). About 30-40% of the patients with CKD stage 3 had mild or no lesions in the histological evaluation (Chronicity Score = 0-1), whereas 7-10% of those with CKD stage 1 had moderate or severe histological lesions (Chronicity Score ≥ 3). Different patients with the same value of estimated glomerular filtration rate (eGFR) had either severe or no histological damage. CONCLUSIONS The variability of kidney histology observed within each CKD stage is not negligible. This may limit the reliability of the current CKD classification. More research is needed to clarify the relationship between CKD stages and kidney damage.
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Affiliation(s)
- Francesco Trevisani
- Unit of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Urological Research Institute (URI), Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Di Marco
- Urological Research Institute (URI), Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Unit of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Urological Research Institute (URI), Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Alessandra Cinque
- Urological Research Institute (URI), Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Larcher
- Unit of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Urological Research Institute (URI), Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Lucianò
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Arianna Bettiga
- Urological Research Institute (URI), Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Vago
- Urological Research Institute (URI), Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Unit of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Urological Research Institute (URI), Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salonia
- Unit of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Urological Research Institute (URI), Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Urological Research Institute (URI), Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Esteban Porrini
- Facultad de Medicina, ITB: Instituto de Tecnologías Biomédicas, Universidad de La Laguna, 38320, La Laguna, Spain.
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19
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Senanayake S, Graves N, Healy H, Baboolal K, Barnett A, Sypek MP, Kularatna S. Donor Kidney Quality and Transplant Outcome: An Economic Evaluation of Contemporary Practice. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1561-1569. [PMID: 33248511 DOI: 10.1016/j.jval.2020.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/11/2020] [Accepted: 07/18/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The study had two main aims. First, we assessed the cost-effectiveness of transplanting deceased donor kidneys of differing quality levels based on the Kidney Donor Profile Index (KDPI). Second, we assessed the cost-effectiveness of remaining on the waiting list until a high-quality kidney becomes available compared to transplanting a lower-quality kidney. METHODS A decision analytic model to estimate cost-effectiveness was developed using a Markov process. Separate models were developed for 4 separate KDPI bands, with higher values indicating lower quality. Models were simulated in 1-year cycles for a 20-year time horizon, with transitions through distinct health states relevant to the kidney recipient from the healthcare payer's perspective. Weibull regression was used to calculate the time-dependent transition probabilities in the base analysis. The impact uncertainty arising in model parameters was included by probabilistic sensitivity analysis using the Monte Carlo simulation method. Willingness to pay was considered as Australian $28 000. RESULTS Transplanting a kidney of any quality is cost-effective compared to remaining on a waitlist. Transplanting a lower KDPI kidney is cost-effective compared to a higher KDPI kidney. Transplanting lower KDPI kidneys to younger patients and higher KDPI kidneys to older patients is also cost-effective. Depending on dialysis in hopes of receiving a lower KDPI kidney is not a cost-effective strategy for any age group. CONCLUSION Efforts should be made by the health systems to reduce the discard rates of low-quality kidneys with the view of increasing the transplant rates.
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Affiliation(s)
- Sameera Senanayake
- Queensland University of Technology, Australian Center for Health Service Innovation, Brisbane, Australia; Ministry of Health, Colombo, Sri Lanka.
| | - Nicholas Graves
- Queensland University of Technology, Australian Center for Health Service Innovation, Brisbane, Australia
| | - Helen Healy
- Royal Brisbane Hospital for Women, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Keshwar Baboolal
- Royal Brisbane Hospital for Women, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Adrian Barnett
- Queensland University of Technology, Australian Center for Health Service Innovation, Brisbane, Australia
| | - Matthew P Sypek
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
| | - Sanjeewa Kularatna
- Queensland University of Technology, Australian Center for Health Service Innovation, Brisbane, Australia
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20
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Nguefouet Momo RE, Donato P, Ugolini G, Nacchia F, Mezzetto L, Veraldi GF, Marletta S, Cavallo E, Eccher A, Giambanco A, Cenzi D, Boschiero L. Kidney transplantation from living donor with monolateral renal artery fibromuscular dysplasia using a cryopreserved iliac graft for arterial reconstruction: a case report and review of the literature. BMC Nephrol 2020; 21:451. [PMID: 33115426 PMCID: PMC7594424 DOI: 10.1186/s12882-020-02097-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/09/2020] [Indexed: 11/11/2022] Open
Abstract
Background Aging and mortality of patients on waiting lists for kidney transplantation have increased, as a result of the shortage of organs available all over the world. Living donor grafts represent a significant source to maintain the donor pool, and resorting successfully to allografts with arterial disease has become a necessity. The incidence of renal artery fibromuscular dysplasia (FMD) in potential living renal donors is reported to be 2–6%, and up to 4% of them present concurrent extra-renal involvement. Case presentation We present a case of renal transplantation using a kidney from a living donor with monolateral FMD. Resection of the affected arterial segment and its subsequent replacement with a cryopreserved iliac artery graft from a deceased donor were performed. No intraoperative nor post-operative complications were reported. The allograft function promptly resumed, with satisfying creatinine clearance, and adequate patency of the vascular anastomoses was detected by Doppler ultrasounds. Conclusion Literature lacks clear guidelines on the eligibility of potential living renal donors with asymptomatic FMD. Preliminary assessment of the FMD living donor should always rule out any extra-renal involvement. Whenever possible, resection and reconstruction of the affected arterial segment should be taken into consideration as this condition may progress after implantation.
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Affiliation(s)
- Rostand Emmanuel Nguefouet Momo
- Unità Dipartimentale Trapianti di Rene, Dipartimento di Chirurgia ed Odontoiatria, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
| | - Paola Donato
- Unità Dipartimentale Trapianti di Rene, Dipartimento di Chirurgia ed Odontoiatria, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Gabriele Ugolini
- Unità Dipartimentale Trapianti di Rene, Dipartimento di Chirurgia ed Odontoiatria, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesco Nacchia
- Unità Dipartimentale Trapianti di Rene, Dipartimento di Chirurgia ed Odontoiatria, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Luca Mezzetto
- Unità Operativa di Chirurgia Vascolare, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Gian Franco Veraldi
- Unità Operativa di Chirurgia Vascolare, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Stefano Marletta
- Unità Operativa di Anatomia Patologica, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Enrico Cavallo
- Unità Operativa di Anatomia Patologica, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Albino Eccher
- Unità Operativa di Anatomia Patologica, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Annamaria Giambanco
- Unita operativa di Chirugia Pediatrica, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Daniela Cenzi
- Unità Operativa di Radiologia, Dipartimento di Radiologia, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Luigino Boschiero
- Unità Dipartimentale Trapianti di Rene, Dipartimento di Chirurgia ed Odontoiatria, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
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21
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Pippias M, Jager KJ, Åsberg A, Berger SP, Finne P, Heaf JG, Kerschbaum J, Lempinen M, Magaz Á, Massy ZA, Stel VS. Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20-50 years: a study by the ERA-EDTA Registry. Nephrol Dial Transplant 2020; 35:534-543. [PMID: 30203080 DOI: 10.1093/ndt/gfy268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/04/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Updated survival outcomes of young recipients receiving young or old deceased donor kidneys are required when considering accepting a deceased donor kidney. METHODS We examined outcomes in 6448 European kidney allografts donated from younger (≥20-<50 years) and older (≥50-<70 years) deceased donors when transplanted into very young (≥20-<35 years) or young (≥35-<50 years) adult recipients. Outcomes of first kidney transplantations during 2000-13 and followed-up to 2015 were determined via competing risk, restricted mean survival and Cox regression methods. RESULTS The 10-year cumulative incidence of graft failure was lowest in very young {22.0% [95% confidence interval (95% CI) 19.1-24.9]} and young [15.3% (95% CI 13.7-16.9)] recipients of younger donor kidneys and highest in very young [36.7% (95% CI 31.9-41.5)] and young [29.2% (95% CI 25.1-33.2)] recipients of older donor kidneys. At the 10-year follow-up, younger donor kidneys had a 1 year (very young) or 9 months (young) longer mean graft survival time compared with older donor kidneys. Graft failure risk in younger donor kidneys was 45% [very young adjusted hazard ratio (aHR) 0.55 (95% CI 0.44-0.68)] and 40% [young aHR 0.60 (95% CI 0.53-0.67)] lower compared with older donor kidneys. A 1-year increase in donor age resulted in a 2% [very young aHR 1.02 (95% CI 1.00-1.04)] or 1% [young aHR 1.01 (95% CI 1.00-1.01)] increase in the 10-year risk of death. CONCLUSIONS Younger donor kidneys show survival benefits over older donor kidneys in adult recipients ages 20-50 years. Updated survival outcomes from older deceased donors are necessary due to advances in transplantation medicine and the increasing role these donors play in organ transplantation.
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Affiliation(s)
- Maria Pippias
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Stefan P Berger
- Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Patrik Finne
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Julia Kerschbaum
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Marko Lempinen
- Department of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Ángela Magaz
- Unidad de Información sobre Pacientes Renales de la Comunidad Autónoma del País Vasco (UNIPAR), Basque Country, Spain
| | - Ziad A Massy
- Division of Nephrology, Ambroise Pare University Hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt/Paris, France.,Institut National de la Sante et de la Recherche Medicale (INSERM) U1018, Team 5, CESP UVSQ, University Paris Saclay, Villejuif, France
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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22
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Jun H, Kim YH, Kim JK, Kim CD, Yang J, Ahn C, Han SY. Outcomes of kidney transplantation from elderly deceased donors of a Korean registry. PLoS One 2020; 15:e0232177. [PMID: 32525880 PMCID: PMC7289373 DOI: 10.1371/journal.pone.0232177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/23/2020] [Indexed: 12/04/2022] Open
Abstract
To overcome organ shortage, expanded criteria donors, including elderly deceased donors (DDs), should be considered. We analyzed outcomes of kidney transplantation (KT) from elderly DDs in a nationwide study. In total, data of 1049 KTs from DDs using the database of Korean Organ Transplantation Registry (KOTRY) were retrospectively analyzed based on the age of DDs: age ≥60 years vs. <60 years. Clinical information, graft status, and adverse events were reviewed in DDs and recipients. The mean age of the 1006 DDs was 51.04±10.54 years, and 21.5% of donors were aged ≥60 years. Elderly DDs had a significantly higher prevalence of diabetes and hypertension and higher Kidney Donor Risk Index (KDRI) and Kidney Donor Profile Index (KDPI). The mean age of the recipients was 47.45±14.87 years. Patients who received KT from elderly DDs were significantly older (53.12±15.14 vs. 45.88±14.41, P<0.001) and had a higher rate of diabetes (41.9 vs. 24.4%, P<0.001). Graft outcomes were not significantly different. Renal function was similar between the groups at the time of discharge and at 6 months, 1 year, and 2 years after KT. The rate of delayed graft function (DGF) was not significantly different. Risk factors of DGF were significantly different in DDs aged ≥60 years and <60 years. In the multivariable model, male sex (odds ratio: 3.99, 95% confidence interval: 1.42–11.22; P = 0.009) and KDRI (12.17, 2.23–66.34; P = 0.004) were significant risk factors for DGF in DDs aged ≥60 years. In DDs aged <60 years, thymoglobulin induction (2.62, 1.53–4.48; P<0.001) and continuous renal replacement therapy (3.47, 1.52–7.96; P = 0.003) were significant factors. Our data indicated that graft outcomes, including renal function and DGF, were similar for elderly DDs and DDs aged <60 years. Elderly DDs might be considered tolerable donors for KT, with active preoperative surveillance.
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Affiliation(s)
- Heungman Jun
- Department of Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Joong Kyung Kim
- Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu Korea
| | - Jaeseok Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Youb Han
- Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
- * E-mail:
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23
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Süsal C, Kumru G, Döhler B, Morath C, Baas M, Lutz J, Unterrainer C, Arns W, Aubert O, Bara C, Beiras-Fernandez A, Böhmig GA, Bösmüller C, Diekmann F, Dutkowski P, Hauser I, Legendre C, Lozanovski VJ, Mehrabi A, Melk A, Minor T, Mueller TF, Pisarski P, Rostaing L, Schemmer P, Schneeberger S, Schwenger V, Sommerer C, Tönshoff B, Viebahn R, Viklicky O, Weimer R, Weiss KH, Zeier M, Živčić-Ćosić S, Heemann U. Should kidney allografts from old donors be allocated only to old recipients? Transpl Int 2020; 33:849-857. [PMID: 32337766 DOI: 10.1111/tri.13628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/06/2019] [Accepted: 04/22/2020] [Indexed: 02/05/2023]
Abstract
In several deceased donor kidney allocation systems, organs from elderly donors are allocated primarily to elderly recipients. The Eurotransplant Senior Program (ESP) was implemented in 1999, and since then, especially in Europe, the use of organs from elderly donors has steadily increased. The proportion of ≥60-year-old donors reported to the Collaborative Transplant Study (CTS) by European centers has doubled, from 21% in 2000-2001 to 42% in 2016-2017. Therefore, in the era of organ shortage it is a matter of debate whether kidney organs from elderly donors should only be allocated to elderly recipients or whether <65-year-old recipients can also benefit from these generally as "marginal" categorized organs. To discuss this issue, a European Consensus Meeting was organized by the CTS on April 12, 2018, in Heidelberg, in which 36 experts participated. Based on available evidence, it was unanimously concluded that kidney organs from 65- to 74-year-old donors can also be allocated to 55- to 64-year-old recipients, especially if these organs are from donors with no history of hypertension, no increased creatinine, no cerebrovascular death, and no other reasons for defining a marginal donor, such as diabetes or cancer.
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Affiliation(s)
- Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gizem Kumru
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Morath
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marije Baas
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jens Lutz
- Division of Nephrology and Infectious Diseases, Medical Clinic, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany
| | | | - Wolfgang Arns
- Department of Nephrology and Transplantation, Cologne Merheim Medical Center, Cologne, Germany
| | - Olivier Aubert
- Service de Transplantation Rénale et Unité de Soins Intensifs, AP-HP, Hôpital Necker-Enfants Malades, Paris Descartes University, Paris, France
| | - Christoph Bara
- Division of Thoracic Transplantation and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andres Beiras-Fernandez
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University, Mainz, Germany
| | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Claudia Bösmüller
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Fritz Diekmann
- Department of Nephrology and Renal Transplantation, ICNU, Hospital Clinic, Barcelona, Spain
| | - Philipp Dutkowski
- Department of Surgery and Transplantation, Swiss HPB and Transplantation Center, University Hospital Zurich, Zurich, Switzerland
| | - Ingeborg Hauser
- Department of Nephrology, Medinizische Klinik III, UKF, Goethe University, Frankfurt, Germany
| | - Christophe Legendre
- Service de Transplantation Rénale et Unité de Soins Intensifs, AP-HP, Hôpital Necker-Enfants Malades, Paris Descartes University, Paris, France
| | - Vladimir J Lozanovski
- Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Thomas Minor
- Department of Surgical Research, Clinic for General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Germany
| | - Thomas F Mueller
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Przemyslaw Pisarski
- Department for General and Visceral Surgery, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Lionel Rostaing
- Service de Néphrologie, Dialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Peter Schemmer
- Department of Surgery, General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| | - Stefan Schneeberger
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Vedat Schwenger
- Department of Nephrology and Autoimmune Diseases, Transplantation Center, Klinikum Stuttgart, Stuttgart, Germany
| | - Claudia Sommerer
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Richard Viebahn
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ondrej Viklicky
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Rolf Weimer
- Department of Internal Medicine, University of Giessen, Giessen, Germany
| | - Karl-Heinz Weiss
- Department of Internal Medicine IV, Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stela Živčić-Ćosić
- Department of Nephrology, Dialysis and Kidney Transplantation, Faculty of Medicine, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Degree of Glomerulosclerosis in Procurement Kidney Biopsies from Marginal Donor Kidneys and Their Implications in Predicting Graft Outcomes. J Clin Med 2020; 9:jcm9051469. [PMID: 32422905 PMCID: PMC7291279 DOI: 10.3390/jcm9051469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background: This study aimed to assess the association between the percentage of glomerulosclerosis (GS) in procurement allograft biopsies from high-risk deceased donor and graft outcomes in kidney transplant recipients. Methods: The UNOS database was used to identify deceased-donor kidneys with a kidney donor profile index (KDPI) score > 85% from 2005 to 2014. Deceased donor kidneys were categorized based on the percentage of GS: 0-10%, 11-20%, >20% and no biopsy performed. The outcome included death-censored graft survival, patient survival, rate of delayed graft function, and 1-year acute rejection. Results: Of 22,006 kidneys, 91.2% were biopsied showing 0-10% GS (58.0%), 11-20% GS (13.5%), >20% GS (19.7%); 8.8% were not biopsied. The rate of kidney discard was 48.5%; 33.6% in 0-10% GS, 68.9% in 11-20% GS, and 77.4% in >20% GS. 49.8% of kidneys were discarded in those that were not biopsied. Death-censored graft survival at 5 years was 75.8% for 0-10% GS, 70.9% for >10% GS, and 74.8% for the no biopsy group. Among kidneys with >10% GS, there was no significant difference in death-censored graft survival between 11-20% GS and >20% GS. Recipients with >10% GS had an increased risk of graft failure (HR = 1.27, p < 0.001), compared with 0-10% GS. There was no significant difference in patient survival, acute rejection at 1-year, and delayed graft function between 0% and 10% GS and >10% GS. Conclusion: In >85% KDPI kidneys, our study suggested that discard rates increased with higher percentages of GS, and GS >10% is an independent prognostic factor for graft failure. Due to organ shortage, future studies are needed to identify strategies to use these marginal kidneys safely and improve outcomes.
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25
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Howard RJ. We listed patients and we should transplant them. Clin Transplant 2020; 34:e13882. [PMID: 32294274 DOI: 10.1111/ctr.13882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/19/2020] [Accepted: 04/07/2020] [Indexed: 11/27/2022]
Abstract
Twenty percent of kidneys recovered for transplantation are discarded. The most common reason for not transplanting these kidneys is to organ quality and biopsy findings. Yet, organ quality measures are not associated with discard rates and kidneys with poorer quality measures lead to greater life span for the recipient compared to staying on dialysis. Biopsy findings are not correlated with graft survival in most cases. The risk aversion of transplant centers from using "high-risk" kidneys can be, in part at least, attributed to negative consequences of poor graft survival with possible program sanctions or possible loss of insurance contracts. CMS has taken a first step by eliminating short-term graft survival as a performance measure for transplant centers. Many of the discarded kidneys will provide good results if transplanted and would recognize that patients value getting a transplant above graft survival.
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Kulu Y, Khajeh E, Ghamarnejad O, Nikdad M, Sabagh M, Ali-Hasan-Al-Saegh S, Nadalin S, Quante M, Pisarski P, Jänigen B, Reißfelder C, Mieth M, Morath C, Goeppert B, Schirmacher P, Strobel O, Hackert T, Zeier M, Springel R, Schleicher C, Büchler MW, Mehrabi A. Expanding pancreas donor pool by evaluation of unallocated organs after brain death: Study protocol clinical trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e19335. [PMID: 32150070 PMCID: PMC7478640 DOI: 10.1097/md.0000000000019335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Pancreas graft quality directly affects morbidity and mortality rates after pancreas transplantation (PTx). The criteria for pancreas graft allocation are restricted, which has decreased the number of available organs. Suitable pancreatic allografts are selected based on donor demographics, medical history, and the transplant surgeon's assessment of organ quality during procurement. Quality is assessed based on macroscopic appearance, which is biased by individual experience and personal skills. Therefore, we aim to assess the histopathological quality of unallocated pancreas organs to determine how many unallocated organs are potentially of suitable quality for PTx. METHODS AND ANALYSIS This is a multicenter cross-sectional explorative study. The demographic data and medical history of donor and cause of rejection of the allocation of graft will be recorded. Organs of included donors will be explanted and macroscopic features such as weight, color, size, and stiffness will be recorded by 2 independent transplant surgeons. A tissue sample of the organ will be fixed for further microscopic assessments. Histopathologic assessments will be performed as soon as a biopsy can be obtained. We will evaluate up to 100 pancreata in this study. RESULT This study will evaluate the histopathological quality of unallocated pancreas organs from brain-dead donors to determine how many of these unallocated organs were potentially suitable for transplantation based on a histopathologic evaluation of organ quality. CONCLUSION The comprehensive findings of this study could help to increase the pancreas graft pool, overcome organ shortage, reduce the waiting time, and also increase the number of PTx in the future. Registration number: ClinicalTrials.gov: NCT04127266.
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Affiliation(s)
- Yakup Kulu
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Omid Ghamarnejad
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Mohammadsadegh Nikdad
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Mohammadsadegh Sabagh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Sadeq Ali-Hasan-Al-Saegh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Silvio Nadalin
- Department of General, Visceral, and Transplant Surgery, University Hospital Tuebingen, Tuebingen
| | - Markus Quante
- Department of General, Visceral, and Transplant Surgery, University Hospital Tuebingen, Tuebingen
| | - Przemyslaw Pisarski
- Transplantation Center, Department of General and Visceral Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Bernd Jänigen
- Transplantation Center, Department of General and Visceral Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim
| | - Markus Mieth
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Christian Morath
- Department of Nephrology, Heidelberg University Hospital, Heidelberg
| | | | | | - Oliver Strobel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Martin Zeier
- Department of Nephrology, Heidelberg University Hospital, Heidelberg
| | | | | | - Markus W. Büchler
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
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Assessing the Limits in Kidney Transplantation: Use of Extremely Elderly Donors and Outcomes in Elderly Recipients. Transplantation 2020; 104:176-183. [DOI: 10.1097/tp.0000000000002748] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Echterdiek F, Schwenger V, Döhler B, Latus J, Kitterer D, Heemann U, Süsal C. Kidneys From Elderly Deceased Donors-Is 70 the New 60? Front Immunol 2019; 10:2701. [PMID: 31827468 PMCID: PMC6890834 DOI: 10.3389/fimmu.2019.02701] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/04/2019] [Indexed: 01/26/2023] Open
Abstract
There is a growing shortage of kidney donors leading to extended transplant waiting times associated with increased mortality. To expand the donor pool, clinicians nowadays regularly accept organs from elderly donors, including those aged ≥70 years. There is only limited and conflicting data whether kidneys from these elderly donors allow for satisfactory allograft outcome rates. To asses this question, the 5-year death censored graft survival of 116,870 adult first deceased donor kidney allograft recipients that were transplanted at European centers between 1997 and 2016 and reported to the “Collaborative Transplant Study” were analyzed using Kaplan–Meier analysis and country stratified Cox regression. The combinations of the two transplant periods 1997–2006 and 2007–2016 with the donor age categories 18–49, 50–59, 60–69, and ≥70 years were considered. From 1997–2006 to 2007–2016, the median donor age increased from 50 to 55 years and the proportion of kidneys from ≥60-year-old donors rose from 24.1 to 38.8%. At the same time, the proportion of kidneys from ≥70-year-old donors more than doubled (6.7 vs. 15.4%). Between 1997–2006 and 2007–2016, the 5-year graft survival improved in all donor age categories. During 2007–2016, the 5-year death censored graft survival of kidneys from ≥70-year-old donors was comparable to that of kidneys from 60 to 69-year-old donors during 1997–2006. This was true both for younger recipients (18–64 years) and older recipients (≥65 years). Among the younger recipients, 45–64-year-old recipients showed the best death censored graft survival rates for kidneys from old donors. In the country-stratified Cox regression analysis, compared to the reference of grafts from 18 to 49-year-old donors, the hazard ratio for grafts from ≥70-year-old donors during 2007–2016 was 1.92, exactly the same as the hazard ratio for grafts from 60 to 69-year-old donors during 1997–2006. Our analysis indicates that within only one further decade (1997–2006 vs. 2007–2016) the 5-year death censored graft survival of kidneys from ≥70-year old donors improved to the level of kidneys from 60 to 69-year-old donors in the previous decade.
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Affiliation(s)
| | - Vedat Schwenger
- Department of Nephrology, Klinikum Stuttgart, Stuttgart, Germany
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Joerg Latus
- Department of Nephrology, Klinikum Stuttgart, Stuttgart, Germany
| | - Daniel Kitterer
- Department of Nephrology, Klinikum Stuttgart, Stuttgart, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
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Salvadori M, Tsalouchos A. Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best? World J Transplant 2019; 9:62-80. [PMID: 31523629 PMCID: PMC6715576 DOI: 10.5500/wjt.v9.i4.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/21/2019] [Accepted: 07/30/2019] [Indexed: 02/05/2023] Open
Abstract
Organ shortage represents one of the major limitations to the development of kidney transplantation. To increase the donor pool and to answer the ever increasing kidney request, physicians are recurring to marginal kidneys as kidneys from older donors, from hypertensive or diabetic donors and from non-heart beating donors. These kidneys are known to have frequently a worse outcome in the recipients. To date major problem is to evaluate such kidneys in order to use or to discard them before transplantation. The use of such kidneys create other relevant question as whether to use them as single or dual transplant and to allocate them fairly according transplant programs. The pre-transplant histological evaluation, the clinical evaluation of the donor or both the criteria joined has been used and according the time each criterion prevailed over the others. Aim of this review has been to examine the advantages and the drawbacks of any criterion and how they have changed with time. To date any criterion has several limitations and several authors have argued for the development of new guidelines in the field of the kidney evaluation for transplantation. Several authors argue that the use of omic technologies should improve the organ evaluation and studies are ongoing to evaluate these technologies either in the donor urine or in the biopsies taken before transplantation.
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Affiliation(s)
- Maurizio Salvadori
- Department of Transplantation Renal Unit, Careggi University Hospital, viale Pieraccini 18, Florence 50139, Italy
| | - Aris Tsalouchos
- Nephrology and Dialysis Unit, Saints Cosmas and Damian Hospital, Via Cesare Battisti, Pescia (PT) 2-51017, Italy
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Brar A, Yap E, Gruessner A, Gruessner R, Jindal RM, Nee R, Sattar M, Salifu MO. Trends and outcomes in dual kidney transplantation- A narrative review. Transplant Rev (Orlando) 2019; 33:154-160. [DOI: 10.1016/j.trre.2019.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/20/2018] [Accepted: 01/09/2019] [Indexed: 12/13/2022]
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Teixeira AC, Ferreira E, Marques MG, Rodrigues L, Santos L, Romãozinho C, Afonso N, Sousa V, Ferreira C, Macário F, Alves R, Figueiredo A. Pretransplant Biopsy of Marginal Kidneys: Is It Necessary? Transplant Proc 2019; 51:1585-1589. [PMID: 31155197 DOI: 10.1016/j.transproceed.2019.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Pretransplant kidney biopsy from marginal donors is used to guide the decision of whether to accept or discard organs for transplantation; however, there is controversy about this procedure, and the need for a pretransplant biopsy is still a debate. We sought to determine if histologic evaluation before implantation of marginal kidneys would influence the outcome. METHODS A retrospective observational cohort study of marginal donor transplants at Centro Hospitalar e Universitário de Coimbra was done. From 2009 to 2016, 650 marginal kidney transplants were analyzed. We evaluated long-term graft survival in a cohort of patients who received marginal kidneys. The recipients were divided into 2 groups based on whether a pretransplant donor biopsy was performed. Continuous variables were summarized by mean and standard deviation or median and range, as applicable. Categorical variables were summarized by relative and absolute frequencies. The survival analysis was obtained and plotted using the Kaplan-Meier method and compared with the log-rank test. RESULTS The median age of recipients and donors were statistically different between both groups (P < .001), with the donors and the recipients being younger in the group without a pretransplant biopsy. The median cold ischemia time was higher in the biopsy group (P = .01). The survival analysis showed that graft survival didn't differ between the groups (P = .2). CONCLUSIONS Selection of kidneys based on histological findings may not influence the graft survival and implies a higher cold ischemia time. More data are necessary to provide insight into which clinical, histologic, and biochemical parameters are necessary for decision making on kidney acceptance.
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Affiliation(s)
- A C Teixeira
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - E Ferreira
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M G Marques
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - L Rodrigues
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - L Santos
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - C Romãozinho
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - N Afonso
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - V Sousa
- Pathology Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - C Ferreira
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - F Macário
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - R Alves
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A Figueiredo
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
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Moeckli B, Sun P, Lazeyras F, Morel P, Moll S, Pascual M, Bühler LH. Evaluation of donor kidneys prior to transplantation: an update of current and emerging methods. Transpl Int 2019; 32:459-469. [PMID: 30903673 DOI: 10.1111/tri.13430] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/18/2019] [Indexed: 02/06/2023]
Abstract
The lack of suitable kidney donor organs has led to rising numbers of patients with end stage renal disease waiting for kidney transplantation. Despite decades of clinical experience and research, no evaluation process that can reliably predict the outcome of an organ has yet been established. This review is an overview of current methods and emerging techniques in the field of donor kidney evaluation prior to transplantation. Established techniques like histological evaluation, clinical scores, and machine perfusion systems offer relatively reliable predictions of delayed graft function but are unable to consistently predict graft survival. Emerging techniques including molecular biomarkers, new imaging technologies, and normothermic machine perfusion offer innovative approaches toward a more global evaluation of an organ with better outcome prediction and possibly even identification of targets for therapeutic interventions prior to transplantation. These techniques should be studied in randomized controlled trials to determine whether they can be safely used in routine clinical practice to ultimately reduce the discard rate and improve graft outcomes.
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Affiliation(s)
- Beat Moeckli
- Department of Surgery and Transplantation, Zurich University Hospital, Zurich, Switzerland
| | - Pamela Sun
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - François Lazeyras
- Department of Radiology and Medical Informatics, CIBM, Geneva University Hospital, Geneva, Switzerland
| | - Philippe Morel
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Solange Moll
- Department of Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Manuel Pascual
- Transplantation Center Lausanne, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Léo H Bühler
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
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Analysis of Risk Factors for Allograft Outcome Comparing 2 Kidneys From the Same Donor in Separate Recipients. Transplant Proc 2018; 50:3211-3215. [PMID: 30577187 DOI: 10.1016/j.transproceed.2018.08.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/31/2018] [Accepted: 08/16/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND An analysis of 2 kidney transplants from the same donor at the same center enables us to analyze the influence of risk factors on the outcome of the grafts in different recipients. METHODS We retrospectively analyzed 88 kidneys from 44 donors that were implanted in 88 recipients at our institution between 2007-2016. We defined unsatisfactory outcome as glomerular filtration rate <30 mL/min/1.73 m2 allograft loss or recipient death within the first year after transplantation. Fifty-three kidneys were allocated and age-matched to donors above the age of 65 years (via Eurotransplant Senior Program or center offer). We compared kidney pairs with satisfactory outcome in both recipients (group A) to pairs with divergent outcome (group B) and unsatisfactory outcome in both recipients (group C). RESULTS Thirty-four grafts (17 donors) had a satisfactory outcome for both recipients (group A), and 16 grafts (8 donors) had an unsatisfactory outcome for both recipients (group C). Donor age was significantly higher in group C vs group A (67.5 ± 6.7 vs 56.4 ± 16.0 years, P = .010). The 19 donors donating 1 kidney with satisfactory and the other with unsatisfactory outcome were 67.4 ± 10.7 years old (group B). A severe surgical complication occurred more often in recipients with an unsatisfactory outcome in comparison to patients with a satisfactory outcome. CONCLUSION Donor age is an important risk factor for an unsatisfactory outcome, either in one or both kidneys of the same donor.
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Bikbov B. R Open Source Programming Code for Calculation of the Kidney Donor Profile Index and Kidney Donor Risk Index. KIDNEY DISEASES (BASEL, SWITZERLAND) 2018; 4:269-272. [PMID: 30574504 PMCID: PMC6276747 DOI: 10.1159/000492427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/25/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Kidney Donor Profile Index (KDPI) and Kidney Donor Risk Index (KDRI) were developed by the United States Organ Procurement and Transplantation Network (OPTN). They may influence the clinical decision whether to accept or discard a donor kidney, but still there are debates about KDPI/KDRI applicability and its consequences. To further evaluate these indexes in different populations, more data should be analyzed, and a universally applicable program code would facilitate it. Currently, KDPI/KDRI calculation could be readily done only on the OPTN website that is convenient for a single donor, but not suitable for processing data sets with many records. SUMMARY A universally applicable program algorithm in widely used R language for calculating KDPI and KDRI was developed according to donor factors and coefficients described in the OPTN guide. KEY MESSAGES The open R code permits to calculate KDPI/KDRI either for a single donor or for an unlimited number of records in large data sets. The presented software code would save substantial time to research groups all over the world and help to clarify the KDPI/KDRI role in global settings.
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Affiliation(s)
- Boris Bikbov
- Academician V.I.Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation
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35
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Colussi G, Casati C, Colombo VG, Camozzi MLP, Salerno FR. Renal transplants from older deceased donors: Is pre-implantation biopsy useful? A monocentric observational clinical study. World J Transplant 2018; 8:110-121. [PMID: 30148077 PMCID: PMC6107519 DOI: 10.5500/wjt.v8.i4.110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/09/2018] [Accepted: 05/13/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To compare survival of kidney transplants from deceased extended criteria donors (ECD) according to: (1) donor graft histological score; and (2) allocation of high score grafts either to single (SKT) or dual (DKT) transplant.
METHODS Renal biopsy was performed as part of either a newly adopted DKT protocol, or of surveillance protocol in the past. A total 185 ECD graft recipients were categorized according to pre-implantation graft biopsy into 3 groups: SKT with graft score 1 to 4 [SKT(1-4), n = 102]; SKT with donor graft score 5 to 8 [SKT(> 4), n = 30]; DKT with donor graft score 5 to 7 (DKT, n = 53). Graft and patient survival were analyzed by Kaplan-Meier curves and compared by log-rank test. Mean number of functioning graft years by transplant reference, and mean number of dialysis-free life years by donor reference in recipients were also calculated at 1, 3 and 6 years from transplantation.
RESULTS There were no statistically significant differences in graft and patient survival between SKT(1-4) and SKT(> 4), and between SKT(> 4) and DKT. Recipient renal function (plasma creatinine and creatinine clearance) at 1 years did not differ in SKT(1-4) and SKT(> 4) (plasma creatinine 1.71 ± 0.69 and 1.69 ± 0.63 mg/dL; creatinine clearance 49.6 + 18.5 and 52.6 + 18.8 mL/min, respectively); DKT showed statistically lower plasma creatinine (1.46 ± 0.57, P < 0.04) but not different creatinine clearance (55.4 + 20.4). Due to older donor age in the DKT group, comparisons were repeated in transplants from donors older than 70 years, and equal graft and patient survival in SKT and DKT were confirmed. Total mean number of functioning graft years by transplant reference at 1, 3 and 6 post-transplant years were equal between the groups, but mean number of dialysis-free life years by donor reference were significantly higher in SKT (mean difference compared to DKT at 6 years: 292 [IQR 260-318] years/100 donors in SKT(1-4) and 292.5 [(IQR 247.8-331.6) in SKT(> 4)].
CONCLUSION In transplants from clinically suitable ECD donors, graft survival was similar irrespective of pre-implantation biopsy score and of allocation to SKT or DKT. These results suggest use of caution in the use of histology as the only decision criteria for ECD organ allocation.
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Affiliation(s)
- Giacomo Colussi
- Fabio Rosario Salereno, Division of Nephrology, Dialysis and Renal Transplantatation, ASST Grande Ospedale Territoriale Niguarda, Milan 20162, Italy
| | - Costanza Casati
- Fabio Rosario Salereno, Division of Nephrology, Dialysis and Renal Transplantatation, ASST Grande Ospedale Territoriale Niguarda, Milan 20162, Italy
| | - Valeriana Giuseppina Colombo
- Fabio Rosario Salereno, Division of Nephrology, Dialysis and Renal Transplantatation, ASST Grande Ospedale Territoriale Niguarda, Milan 20162, Italy
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Franczyk S, Skrabaka D, Jędrusik E, Ziaja J, Kolonko A, Świder R, Sekta S, Czerwiński J, Owczarek A, Durlik M, Więcek A, Cierpka L, Król R. Results of Transplantation of Kidneys Procured From Donors After Brain Death Aged 60 Years and Older. Transplant Proc 2018; 50:1674-1679. [DOI: 10.1016/j.transproceed.2018.02.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/06/2018] [Indexed: 12/17/2022]
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Casati C, Colombo VG, Perrino M, Rossetti OM, Querques M, Giacomoni A, Binaggia A, Colussi G. Renal Transplants from Older Deceased Donors: Use of Preimplantation Biopsy and Differential Allocation to Dual or Single Kidney Transplant according to Histological Score Has No Advantages over Allocation to Single Kidney Transplant by Simple Clinical Indication. J Transplant 2018; 2018:4141756. [PMID: 29862061 PMCID: PMC5976897 DOI: 10.1155/2018/4141756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Grafts from elderly donors (ECD) are increasingly allocated to single (SKT) or dual (DKT) kidney transplantation according to biopsy score. Indications and benefits of either procedure lack universal agreement. METHODS A total of 302 ECD-transplants in period from Jan 1, 2000, to Dec 31, 2015, were allocated to SKT (SKTpre) on clinical grounds alone (before Dec 2010, pre-DKT era, n = 170) or according to a clinical-histological protocol (after Dec 2010, DKT era, n = 132) to DKT (n = 48), SKT biopsy-based protocol ("high-risk", SKThr, n = 51), or SKT clinically based protocol ("low-risk", SKTlr, n = 33). Graft and patient survival were compared between the two periods and between different transplant categories. RESULTS Graft and overall survival in recipients from ECD in pre-DKT and DKT era did not differ (5-year graft survival 87.7% and 84.2%, resp.); equal survival in the 2 ECD periods was shown in both donor age ranges of 60-69 and >70-years, and in low-risk or high-risk ECD categories. Within the DKT protocol SKThr showed worst graft and overall survival in the 60-69 donor age range; DKT did not result in significantly better outcome than SKT from ECD in either era. One-year posttransplant creatinine clearance in recipients did not differ between any ECD transplant category. At 3 and 5 years after transplantation there were significantly higher total dialysis-free recipient life years from an equal donor number in the pre-DKT era than in the DKT protocol. CONCLUSIONS Use of a biopsy-based protocol to allocate grafts from aged donors to SKT or DKT did not result in better short term graft survival than a clinically based protocol with allocation only to SKT and reduced overall recipient dialysis-free life years in time.
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Affiliation(s)
- Costanza Casati
- Division of Nephrology, Dialysis and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valeriana Giuseppina Colombo
- Division of Nephrology, Dialysis and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marialuisa Perrino
- Division of Nephrology, Dialysis and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Marialuisa Querques
- Division of Nephrology, Dialysis and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Giacomoni
- Division of Transplant Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Agnese Binaggia
- Division of Nephrology, Dialysis and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giacomo Colussi
- Division of Nephrology, Dialysis and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Validation of systems biology derived molecular markers of renal donor organ status associated with long term allograft function. Sci Rep 2018; 8:6974. [PMID: 29725116 PMCID: PMC5934379 DOI: 10.1038/s41598-018-25163-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/03/2018] [Indexed: 12/12/2022] Open
Abstract
Donor organ quality affects long term outcome after renal transplantation. A variety of prognostic molecular markers is available, yet their validity often remains undetermined. A network-based molecular model reflecting donor kidney status based on transcriptomics data and molecular features reported in scientific literature to be associated with chronic allograft nephropathy was created. Significantly enriched biological processes were identified and representative markers were selected. An independent kidney pre-implantation transcriptomics dataset of 76 organs was used to predict estimated glomerular filtration rate (eGFR) values twelve months after transplantation using available clinical data and marker expression values. The best-performing regression model solely based on the clinical parameters donor age, donor gender, and recipient gender explained 17% of variance in post-transplant eGFR values. The five molecular markers EGF, CD2BP2, RALBP1, SF3B1, and DDX19B representing key molecular processes of the constructed renal donor organ status molecular model in addition to the clinical parameters significantly improved model performance (p-value = 0.0007) explaining around 33% of the variability of eGFR values twelve months after transplantation. Collectively, molecular markers reflecting donor organ status significantly add to prediction of post-transplant renal function when added to the clinical parameters donor age and gender.
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39
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Fehr T. Elderly kidney donors: better than their reputation-but where are the limits? Transpl Int 2018; 31:700-702. [PMID: 29665164 DOI: 10.1111/tri.13264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 04/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Fehr
- Department of Internal Medicine, Cantonal Hospital Graubuenden, Chur, Switzerland.,Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
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40
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Ruggenenti P, Remuzzi G. Invited letter in response to: "Is the kidney donor profile index (KDPI) universal or UNOS-specific?". Am J Transplant 2018; 18:1033-1034. [PMID: 29316192 DOI: 10.1111/ajt.14652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Piero Ruggenenti
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Centre for Rare Diseases Aldo e Cele Daccò, Bergamo, Italy.,Nephrology and Dialysis Unit, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Centre for Rare Diseases Aldo e Cele Daccò, Bergamo, Italy.,Nephrology and Dialysis Unit, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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