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Scurt FG, Hammoud B, Bose K, Mertens PR, Chatzikyrkou C. Short-Term, Mid-Term, and Long-Term Outcomes after Deceased Donor Kidney Transplantation in Patients with AKI: A Systematic Review and Meta-Analysis. KIDNEY360 2024; 5:1012-1031. [PMID: 38668857 PMCID: PMC11296548 DOI: 10.34067/kid.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/17/2024] [Indexed: 07/26/2024]
Abstract
Key Points This study reviews the willingness to use kidneys from donors who have experienced AKI during transplantation and provides a thorough analysis of the existing literature. While delayed graft function is more common, primary nonfunction and acute rejection rates appear comparable, as do allograft function and graft survival compared with non-AKI donor kidneys. Considering the shortage of available organs and the high mortality rate of patients on dialysis, the use of donors with AKI as a source for kidney transplantation is a viable alternative. Background AKI is a common complication in hospitalized patients and may occur in potential kidney donors. Observational studies have suggested that kidney transplantation in patients with AKI is feasible and safe, but no systematic evaluation has been performed. Methods We performed a systematic review and meta-analysis to evaluate the outcomes of kidney transplantation in patients with AKI. We searched MEDLINE, Embase, Cochrane, Google Scholar, and other databases for studies reporting outcomes of donor kidneys with AKI. We included single-center, multicenter, and registry-based studies and analyzed them according to the definition and severity of AKI. End points were primary and delayed graft function (DGF), primary nonfunction (PNF), length of hospital stay, rejection, graft function, and patient and graft survival at 1, 3, 5, and 8–10 years after transplantation. This study was registered in PROSPERO, number CRD42021260088. Results We identified 33 single-center, four multicenter, and seven registry studies with more than 100,000 patients published between 2005 and 2022. Recipients from donors with AKI had a higher risk of DGF (relative risk, 1.51; 95% confidence interval [CI], 1.35 to 1.68). Graft function at discharge was worse in the AKI group (MDCrea [95% CI]: 0.96 mg/dl [0.36 to 1.56, I2=96%], MDGFR [95% CI]: −8.88 ml/min per 1.73 m2 [−15.32 to −2.44, I2=93%]), but improved thereafter and was similar in both groups at 3 months after transplantation (MDCrea [95% CI]: −0.05 mg/dl [−0.18 to 0.07, I2=0%], MDGFR [95% CI]: −1.83 ml/min per 1.73 m2 [−5.29 to 1.63, I2=91%]). Primary nonfunction and patient and graft survival were similar at 1, 3, 5, and 8–10 years after transplantation. There were no differences in rejections regardless of AKI definition and severity. Conclusions Transplantation of kidneys with AKI is associated with satisfactory short-term and long-term outcomes and should be pursued to increase the donor pool.
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Affiliation(s)
- Florian G. Scurt
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Ben Hammoud
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Katrin Bose
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Peter R. Mertens
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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2
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Moein M, Iskhagi S, Shahbazov R, Ball A, Loerzel S, Shaban E, Hod Dvorai R, Hanlon M, Saidi RF. Deceased Donor Kidney Transplantation From Donors With Acute Kidney Injury: Realities and Costs. EXP CLIN TRANSPLANT 2023; 21:104-109. [PMID: 36919718 DOI: 10.6002/ect.2022.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVES Transplant of kidneys from donors with acute kidney injury has shown favorable outcomes. We investigated the outcomes of kidney transplant recipients with deceased donors who developed acute kidney injury before organ procurement. MATERIALS AND METHODS We retrospectively reviewed the medical records of recipients from January 2016 to December 2021 in a single center. Outcomes in recipients of kidney grafts from donors with and without acute kidney injury were compared. RESULTS The mean follow-up time was 40 months. Our study included 129 (34%) kidneys transplanted from donors with acute kidney injury and 251 (66%) kidneys from donors without acute kidney injury. Delayed graft function rate in recipients was 33% in the acute kidney injury group and 25.5% in the group without acute kidney injury (P = .099). Readmission rate at 30 days was significantly higher among recipients of kidneys with acute kidney injury compared with recipients of kidneys without acute kidney injury (45% vs 33.5%; P = .02). The mean overall costs of transplant in the acute kidney injury group were comparable to the group without acute kidney injury ($253 865 vs $253 611; P = .97). The acute rejection rate was comparable between the 2 groups (4% in both groups; P = .96). Delayed graft function rate was increased with increased stage of acute kidney injury (18% stage 1, 45% stage 2, 36% stage 3; P = .03). However, the overall length of hospital stay and costs were comparable among recipients of different stages of acute kidney injury. CONCLUSIONS Our study showed that kidney transplants from donors with acute kidney injury have early and late outcomes comparable to kidney transplants from donors without acute kidney injury. Allografts from donors with acute kidney injury can be used safely and can expand the donor pool in kidney transplant without increasing perioperative resource utilization.
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Affiliation(s)
- Mahmoudreza Moein
- From the Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
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3
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Short-term outcomes after transplantation of deceased donor kidneys with acute kidney injury: a retrospective analysis of a multicenter cohort of marginal donor kidneys with post-explantation biopsies. Int Urol Nephrol 2023; 55:115-127. [PMID: 35809204 PMCID: PMC9807548 DOI: 10.1007/s11255-022-03277-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/04/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Deceased donor kidneys with acute kidney injury (AKI) are often discarded because of concerns about inferior transplant outcomes. A means of grading the quality of such kidneys is the performance of procurement biopsies. METHODS This is a retrospective study of 221 brain death donors with marginal kidneys transplanted in 223 recipients in Germany. Marginal kidneys were defined as kidneys with procurement biopsies done exceptionally to assess suitability for transplantation in otherwise potentially discarded organs. The impact of deceased donor AKI on patient survival and death-censored graft survival at 1, 3 and 5 years and graft function at 1 and 3 years after transplantation was investigated. RESULTS Recipients of kidneys with stage 3 AKI had a greater incidence of delayed graft function [DGF; ORStage 1: 1.435 (95% CI 0.438-0.702), ORStage 2: 2.463 (95% CI 0.656-9.245), ORStage 3: 4.784 (95% CI 1.421-16.101)] but a similar graft and patient survival compared to recipients of donors without AKI and with AKI stage 1 and 2 as well. The coexistence of recipient DGF and donor AKI was associated with the lowest graft survival and function rates. CONCLUSION The transplantation of deceased donor marginal kidneys with AKI confers a higher risk for DGF but is associated with acceptable graft and patient outcomes, which do not differ in comparison with marginal donor kidneys without AKI. Graft prognosis is especially poor if donor AKI and recipient DGF concur. Donor AKI was a risk factor independent of the histological lesions of procurement biopsies.
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4
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Yuan Q, Haque O, Hong S, Ortiz A, Bethea ED, Sise ME, Markmann JF, Elias N. Influence of donor and recipient hepatitis B virus infection on long-term outcomes after kidney transplantation. Clin Transplant 2021; 35:e14466. [PMID: 34545965 DOI: 10.1111/ctr.14466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/23/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The demand for transplantable kidneys continues to outstrip supply, and the risk of donor-derived infection limits utilization. The effect of donor or recipient HBV status, defined by surface antigen (HBsAg) positivity, on long-term survival outcomes of kidney transplant (KT) is unknown. METHODS We conducted a retrospective cohort study based on Organ Procurement and Transplantation Network (OPTN) data from 2000 to 2019. We identified three cohorts based on donor (D) or recipient (R) HBsAg status: D-R, D-R+, and D+R-. Pairwise comparisons of patient survival (PS) and all-cause graft survival (GS) after propensity score matching were performed to assess the effect of HBV infection in KT recipients. RESULTS Our findings showed that there were no statistically significant differences in PS and GS among D-R, D-R+, and D+R-groups, nor was the patient or GS different between donor and recipient HBsAg+ status. Finally, in 2019 kidney discard rates were 15% higher for HBsAg+ deceased donors compared to HBsAg- donors. CONCLUSIONS HBsAg+ status was not associated with worse PS or GS after KT. Prior to broadly advocating utilization of HbsAg+ kidneys, further studies assessing KT recipient morbidity and safety are necessary.
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Affiliation(s)
- Qing Yuan
- Department of Urology, Chinese PLA General Hospital, Beijing, China.,Center for Transplantation Sciences, and Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Omar Haque
- Center for Transplantation Sciences, and Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Shriners Hospitals for Children, Boston, Massachusetts, USA
| | - Shanjuan Hong
- Center for Transplantation Sciences, and Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andric Ortiz
- Center for Transplantation Sciences, and Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily D Bethea
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Division of Gastroenterology and Hepatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meghan E Sise
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James F Markmann
- Center for Transplantation Sciences, and Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nahel Elias
- Center for Transplantation Sciences, and Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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5
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Abstract
The shortage of suitable organs is the biggest obstacle for transplants. At present, most organs for transplant in the United States are from donation after neurologic determination of death (brain death). Potential organs for transplant need to maintain their viability during a series of insults, including the original disease, physiologic derangements during the dying process, ischemia, and reperfusion. Proper donor management before, during, and after procurement has potential to increase the number and quality of organs from donors. Anesthesiologists need to understand the physiologic derangements associated with brain death and the updated donor management during the periprocurement period.
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Affiliation(s)
- Victor W Xia
- Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095, USA.
| | - Michelle Braunfeld
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Anesthesiology, Greater Los Angeles VA Hospital, Los Angeles, CA, USA
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6
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Rege A, Irish B, Castleberry A, Vikraman D, Sanoff S, Ravindra K, Collins B, Sudan D. Trends in Usage and Outcomes for Expanded Criteria Donor Kidney Transplantation in the United States Characterized by Kidney Donor Profile Index. Cureus 2016; 8:e887. [PMID: 28018757 PMCID: PMC5179248 DOI: 10.7759/cureus.887] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
There has been increasing concern in the kidney transplant community about the declining use of expanded criteria donors (ECD) despite improvement in survival and quality of life. The recent introduction of the Kidney Donor Profile Index (KDPI), which provides a more granular characterization of donor quality, was expected to increase utilization of marginal kidneys and decrease the discard rates. However, trends and practice patterns of ECD kidney utilization on a national level based on donor organ quality as per KDPI are not well known. We, therefore, performed a trend analysis of all ECD recipients in the United Network for Organ Sharing (UNOS) registry between 2002 and 2012, after calculating the corresponding KDPI, to enable understanding the trends of usage and outcomes based on the KDPI characterization. High-risk recipient characteristics (diabetes, body mass index ≥30 kg/m2, hypertension, and age ≥60 years) increased over the period of the study (trend test p<0.001 for all). The proportion of ECD transplants increased from 18% in 2003 to a peak of 20.4% in 2008 and then declined thereafter to 17.3% in 2012. Using the KDPI >85% definition, the proportion increased from 9.4% in 2003 to a peak of 12.1% in 2008 and declined to 9.7% in 2012. Overall, although this represents a significant utilization of kidneys with KDPI >85% over time (p<0.001), recent years have seen a decline in usage, probably related to regulations imposed by Centers for Medicare & Medicaid Services (CMS). When comparing the hazards of graft failure by KDPI, ECD kidneys with KDPI >85% have a slightly lower risk of graft failure compared to standard criteria donor (SCD) kidneys with KDPI >85%, with a hazard ratio (HR) of 0.95, a confidence interval (CI) of 0.94-0.96, and statistical significance of p<0.001. This indicates that some SCD kidneys may actually have a lower estimated quality, with a higher Kidney Donor Risk Index (KDRI), than some ECDs. The incidence of delayed graft function (DGF) in ECD recipients has significantly decreased over time from 35.2% in 2003 to 29.6% in 2011 (p=0.007), probably related to better understanding of the donor risk profile along with increased use of hypothermic machine perfusion and pretransplant biopsy to aid in optimal allograft selection. The recent decline in transplantation of KDPI >85% kidneys probably reflects risk-averse transplant center behavior. Whether discard of discordant SCD kidneys with KDPI >85% has contributed to this decline remains to be studied.
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Affiliation(s)
| | - Bill Irish
- Health Outcomes Research & Biostatistics, CTI Clinical Trial and Consulting
| | | | - Deepak Vikraman
- Surgery, Duke University Medical Center ; Division of Abdominal Transplantation, Duke University Medical Center
| | - Scott Sanoff
- Transplant Nephrology, Duke University Medical Center
| | - Kadiyala Ravindra
- Surgery, Duke University Medical Center ; Division of Abdominal Transplantation, Duke University Medical Center
| | | | - Debra Sudan
- Surgery, Duke University Medical Center ; Division of Abdominal Transplantation, Duke University Medical Center
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7
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Criteria for and Appropriateness of Renal Transplantation in Elderly Patients With End-Stage Renal Disease. Transplantation 2016; 100:e55-65. [DOI: 10.1097/tp.0000000000001367] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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8
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Matos ACCD, Requião-Moura LR, Clarizia G, Durão Junior MDS, Tonato EJ, Chinen R, Arruda ÉFD, Filiponi TC, Pires LMDMB, Bertocchi APF, Pacheco-Silva A. Expanding the pool of kidney donors: use of kidneys with acute renal dysfunction. EINSTEIN-SAO PAULO 2015; 13:319-25. [PMID: 26154553 PMCID: PMC4943830 DOI: 10.1590/s1679-45082015rw3147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 02/08/2015] [Indexed: 02/05/2023] Open
Abstract
Given the shortage of organs transplantation, some strategies have been adopted by the transplant community to increase the supply of organs. One strategy is the use of expanded criteria for donors, that is, donors aged >60 years or 50 and 59 years, and meeting two or more of the following criteria: history of hypertension, terminal serum creatinine >1.5mg/dL, and stroke as the donor´s cause of death. In this review, emphasis was placed on the use of donors with acute renal failure, a condition considered by many as a contraindication for organ acceptance and therefore one of the main causes for kidney discard. Since these are well-selected donors and with no chronic diseases, such as hypertension, renal disease, or diabetes, many studies showed that the use of donors with acute renal failure should be encouraged, because, in general, acute renal dysfunction is reversible. Although most studies demonstrated these grafts have more delayed function, the results of graft and patient survival after transplant are very similar to those with the use of standard donors. Clinical and morphological findings of donors, the use of machine perfusion, and analysis of its parameters, especially intrarenal resistance, are important tools to support decision-making when considering the supply of organs with renal dysfunction.
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Affiliation(s)
| | | | - Gabriela Clarizia
- Instituto Israelita de Responsabilidade Social, São Paulo, SP, Brazil
| | | | | | - Rogério Chinen
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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9
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10
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Molecular pathogenesis of post-transplant acute kidney injury: assessment of whole-genome mRNA and miRNA profiles. PLoS One 2014; 9:e104164. [PMID: 25093671 PMCID: PMC4122455 DOI: 10.1371/journal.pone.0104164] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/07/2014] [Indexed: 12/13/2022] Open
Abstract
Acute kidney injury (AKI) affects roughly 25% of all recipients of deceased donor organs. The prevention of post-transplant AKI is still an unmet clinical need. We prospectively collected zero-hour, indication as well as protocol kidney biopsies from 166 allografts between 2011 and 2013. In this cohort eight cases with AKI and ten matched allografts without pathology serving as control group were identified with a follow-up biopsy within the first twelve days after engraftment. For this set the zero-hour and follow-up biopsies were subjected to genome wide microRNA and mRNA profiling and analysis, followed by validation in independent expression profiles of 42 AKI and 21 protocol biopsies for strictly controlling the false discovery rate. Follow-up biopsies of AKI allografts compared to time-matched protocol biopsies, further baseline adjustment for zero-hour biopsy expression level and validation in independent datasets, revealed a molecular AKI signature holding 20 mRNAs and two miRNAs (miR-182-5p and miR-21-3p). Next to several established biomarkers such as lipocalin-2 also novel candidates of interest were identified in the signature. In further experimental evaluation the elevated transcript expression level of the secretory leukocyte peptidase inhibitor (SLPI) in AKI allografts was confirmed in plasma and urine on the protein level (p<0.001 and p = 0.003, respectively). miR-182-5p was identified as a molecular regulator of post-transplant AKI, strongly correlated with global gene expression changes during AKI. In summary, we identified an AKI-specific molecular signature providing the ground for novel biomarkers and target candidates such as SLPI and miR-182-5p in addressing AKI.
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11
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Tanriover B, Mohan S, Cohen DJ, Radhakrishnan J, Nickolas TL, Stone PW, Tsapepas DS, Crew RJ, Dube GK, Sandoval PR, Samstein B, Dogan E, Gaston RS, Tanriover JN, Ratner LE, Hardy MA, Chvojka J, da Motta H, Devan J, Dytman SA, Díaz GA, Eberly B, Felix J, Fields L, Fiorentini GA, Gago AM, Gallagher H, Gran R, Harris DA, Higuera A, Hurtado K, Jerkins M, Kafka T, Kordosky M, Kulagin SA, Le T, Maggi G, Maher E, Manly S, Mann WA, Marshall CM, Martin Mari C, McFarland KS, McGivern CL, McGowan AM, Miller J, Mislivec A, Morfín JG, Muhlbeier T, Naples D, Nelson JK, Norrick A, Osta J, Palomino JL, Paolone V, Park J, Patrick CE, Perdue GN, Rakotondravohitra L, Ransome RD, Ray H, Ren L, Rodrigues PA, Savage DG, Schellman H, Schmitz DW, Simon C, Snider FD, Solano Salinas CJ, Tagg N, Valencia E, Velásquez JP, Walton T, Wolcott J, Zavala G, Zhang D, Ziemer BP. Kidneys at higher risk of discard: expanding the role of dual kidney transplantation. Am J Transplant 2014; 14:404-15. [PMID: 24472195 PMCID: PMC4058786 DOI: 10.1111/ajt.12553] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 01/25/2023]
Abstract
Half of the recovered expanded criteria donor (ECD) kidneys are discarded in the United States. A new kidney allocation system offers kidneys at higher risk of discard, Kidney Donor Profile Index (KDPI)>85%, to a wider geographic area to promote broader sharing and expedite utilization. Dual kidney transplantation (DKT) based on the KDPI is a potential option to streamline allocation of kidneys which otherwise would have been discarded. To assess the clinical utility of the KDPI in kidneys at higher risk of discard, we analyzed the OPTN/UNOS Registry that included the deceased donor kidneys recovered between 2002 and 2012. The primary outcomes were allograft survival, patient survival and discard rate based on different KDPI categories (<80%, 80-90% and >90%). Kidneys with KDPI>90% were associated with increased odds of discard (OR=1.99, 95% CI 1.74-2.29) compared to ones with KDPI<80%. DKTs of KDPI>90% were associated with lower overall allograft failure (HR=0.74, 95% CI 0.62-0.89) and better patient survival (HR=0.79, 95% CI 0.64-0.98) compared to single ECD kidneys with KDPI>90%. Kidneys at higher risk of discard may be offered in the up-front allocation system as a DKT. Further modeling and simulation studies are required to determine a reasonable KDPI cutoff percentile.
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Affiliation(s)
- B. Tanriover
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY,The Columbia University Renal Epidemiology (CURE) Group, Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY,Corresponding author: Bekir Tanriover,
| | - S. Mohan
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY,The Columbia University Renal Epidemiology (CURE) Group, Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - D. J. Cohen
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - J. Radhakrishnan
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - T. L. Nickolas
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY,The Columbia University Renal Epidemiology (CURE) Group, Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - P. W. Stone
- Center for Health Policy, Columbia University School of Nursing, New York, NY
| | - D. S. Tsapepas
- Department of Pharmacy, New York Presbyterian Hospital, New York, NY
| | - R. J. Crew
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - G. K. Dube
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - P. R. Sandoval
- Renal and Pancreatic Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - B. Samstein
- Renal and Pancreatic Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - E. Dogan
- Division of Nephrology, Sutcu Imam University, Kahramanmaras, Turkey
| | - R. S. Gaston
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL
| | | | - L. E. Ratner
- Renal and Pancreatic Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - M. A. Hardy
- Renal and Pancreatic Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - J Chvojka
- University of Rochester, Rochester, New York 14610, USA
| | - H da Motta
- Centro Brasileiro de Pesquisas Físicas, Rua Dr. Xavier Sigaud 150, Urca, Rio de Janeiro, Rio de Janeiro 22290-180, Brazil
| | - J Devan
- Department of Physics, College of William & Mary, Williamsburg, Virginia 23187, USA
| | - S A Dytman
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - G A Díaz
- Sección Física, Departamento de Ciencias, Pontificia Universidad Católica del Perú, Apartado 1761, Lima, Peru
| | - B Eberly
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - J Felix
- Northwestern University, Evanston, Illinois 60208, USA
| | - L Fields
- Northwestern University, Evanston, Illinois 60208, USA
| | - G A Fiorentini
- Centro Brasileiro de Pesquisas Físicas, Rua Dr. Xavier Sigaud 150, Urca, Rio de Janeiro, Rio de Janeiro 22290-180, Brazil
| | - A M Gago
- Sección Física, Departamento de Ciencias, Pontificia Universidad Católica del Perú, Apartado 1761, Lima, Peru
| | - H Gallagher
- Physics Department, Tufts University, Medford, Massachusetts 02155, USA
| | - R Gran
- Department of Physics, University of Minnesota-Duluth, Duluth, Minnesota 55812, USA
| | - D A Harris
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - A Higuera
- Campus León y Campus Guanajuato, Universidad de Guanajuato, Lascurain de Retana No. 5, Col. Centro. Guanajuato 36000, Guanajuato, Mexico
| | - K Hurtado
- Centro Brasileiro de Pesquisas Físicas, Rua Dr. Xavier Sigaud 150, Urca, Rio de Janeiro, Rio de Janeiro 22290-180, Brazil and Universidad Nacional de Ingeniería, Apartado 31139 Lima, Peru
| | - M Jerkins
- Department of Physics, University of Texas, 1 University Station, Austin, Texas 78712, USA
| | - T Kafka
- Physics Department, Tufts University, Medford, Massachusetts 02155, USA
| | - M Kordosky
- Department of Physics, College of William & Mary, Williamsburg, Virginia 23187, USA
| | - S A Kulagin
- Institute for Nuclear Research of the Russian Academy of Sciences, 117312 Moscow, Russia
| | - T Le
- Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, USA
| | - G Maggi
- Departamento de Física, Universidad Técnica Federico Santa María, Avenida España 1680 Casilla 110-V, Valparaíso, Chile
| | - E Maher
- Massachusetts College of Liberal Arts, 375 Church Street, North Adams, Massachusetts 01247, USA
| | - S Manly
- University of Rochester, Rochester, New York 14610, USA
| | - W A Mann
- Physics Department, Tufts University, Medford, Massachusetts 02155, USA
| | - C M Marshall
- University of Rochester, Rochester, New York 14610, USA
| | | | - K S McFarland
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA and University of Rochester, Rochester, New York 14610, USA
| | - C L McGivern
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - A M McGowan
- University of Rochester, Rochester, New York 14610, USA
| | - J Miller
- Departamento de Física, Universidad Técnica Federico Santa María, Avenida España 1680 Casilla 110-V, Valparaíso, Chile
| | - A Mislivec
- University of Rochester, Rochester, New York 14610, USA
| | - J G Morfín
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - T Muhlbeier
- Centro Brasileiro de Pesquisas Físicas, Rua Dr. Xavier Sigaud 150, Urca, Rio de Janeiro, Rio de Janeiro 22290-180, Brazil
| | - D Naples
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - J K Nelson
- Department of Physics, College of William & Mary, Williamsburg, Virginia 23187, USA
| | - A Norrick
- Department of Physics, College of William & Mary, Williamsburg, Virginia 23187, USA
| | - J Osta
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J L Palomino
- Centro Brasileiro de Pesquisas Físicas, Rua Dr. Xavier Sigaud 150, Urca, Rio de Janeiro, Rio de Janeiro 22290-180, Brazil
| | - V Paolone
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - J Park
- University of Rochester, Rochester, New York 14610, USA
| | - C E Patrick
- Northwestern University, Evanston, Illinois 60208, USA
| | - G N Perdue
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA and University of Rochester, Rochester, New York 14610, USA
| | | | - R D Ransome
- Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, USA
| | - H Ray
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - L Ren
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - P A Rodrigues
- University of Rochester, Rochester, New York 14610, USA
| | - D G Savage
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - H Schellman
- Northwestern University, Evanston, Illinois 60208, USA
| | - D W Schmitz
- Enrico Fermi Institute, University of Chicago, Chicago, Illinois 60637, USA
| | - C Simon
- Department of Physics and Astronomy, University of California, Irvine, Irvine, California 92697-4575, USA
| | - F D Snider
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | | | - N Tagg
- Department of Physics, Otterbein University, 1 South Grove Street, Westerville, Ohio 43081, USA
| | - E Valencia
- Campus León y Campus Guanajuato, Universidad de Guanajuato, Lascurain de Retana No. 5, Col. Centro. Guanajuato 36000, Guanajuato, Mexico
| | - J P Velásquez
- Sección Física, Departamento de Ciencias, Pontificia Universidad Católica del Perú, Apartado 1761, Lima, Peru
| | - T Walton
- Department of Physics, Hampton University, Hampton, Virginia 23668, USA
| | - J Wolcott
- University of Rochester, Rochester, New York 14610, USA
| | - G Zavala
- Campus León y Campus Guanajuato, Universidad de Guanajuato, Lascurain de Retana No. 5, Col. Centro. Guanajuato 36000, Guanajuato, Mexico
| | - D Zhang
- Department of Physics, College of William & Mary, Williamsburg, Virginia 23187, USA
| | - B P Ziemer
- Department of Physics and Astronomy, University of California, Irvine, Irvine, California 92697-4575, USA
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Park UJ, Cho WH, Kim HT, Kim MY, Kim YL, Kim CD, Cho JH, Kim YH, Park SJ, Chung SY, Choi SJN, Lee HK, Park SK, Lee S, Yu HC. Evaluation of the Korean Network for Organ Sharing Expanded Donor Criteria in Deceased Donor Renal Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2013. [DOI: 10.4285/jkstn.2013.27.4.166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ui Jun Park
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Won Hyun Cho
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hyoung Tae Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Min Young Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Young Hoon Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Suk Joo Park
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Young Chung
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Jin Na Choi
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Kyun Lee
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Kwang Park
- Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Sik Lee
- Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Hee Chul Yu
- Department of Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
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Wang CJ, Wetmore JB, Kasiske BL. Implications of predonation GFR to recipient and donor outcomes. Nephrol Dial Transplant 2013; 29:5-9. [PMID: 24163270 DOI: 10.1093/ndt/gft322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Connie J Wang
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA
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14
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Access to renal transplantation for the elderly in the face of new allocation policy: a review of contemporary perspectives on "older" issues. Transplant Rev (Orlando) 2013; 28:6-14. [PMID: 24262382 DOI: 10.1016/j.trre.2013.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/01/2013] [Indexed: 11/22/2022]
Abstract
The benefits of renal transplantation have been demonstrated to extend to the elderly. As a result, more seniors have been placed on the kidney transplant wait list and have received renal allografts in recent years. In June 2013 significant amendments to deceased donor kidney allocation policy were approved to be instituted in 2014 with the goal of increasing overall life years and graft years achieved compared to the current system. Going forward, it is conceivable that transplant centers may perceive a need to adjust practice patterns and modify evaluation and listing criteria for the elderly as the proportion of kidneys distributed to this segment of the wait list would potentially decrease under the new system, further increasing wait times. This review examines contemporary perspectives on access to transplantation for seniors and pertinent issues for this subgroup such as wait time, comorbidity, and evaluation and listing practices. Potential approaches to improve the evaluation of elderly patients being considered for transplant and to increase availability of expanded criteria donor (or higher kidney donor profile index) and living donor organ transplant opportunities while maintaining acceptable outcomes for seniors are explored.
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Klair T, Gregg A, Phair J, Kayler LK. Outcomes of adult dual kidney transplants by KDRI in the United States. Am J Transplant 2013; 13:2433-40. [PMID: 23919381 DOI: 10.1111/ajt.12383] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 06/11/2013] [Indexed: 01/25/2023]
Abstract
UNOS guidelines provide inadequate discriminatory criteria for kidneys that should be transplanted as single (SKT) versus dual (DKT). We evaluated the utility of the kidney donor risk index (KDRI) to define kidneys with better outcomes when transplanted as dual. Using SRTR data from 1995 to 2010 of de novo KTX recipients of adult deceased-donor kidneys, we examined outcomes of SKT and DKT stratified by KDRI group ≤1.4 (n = 49 294), 1.41-1.8 (n = 15 674), 1.81-2.2 (n = 6523) and >2.2 (n = 2791). DKT of kidneys with KDRI >2.2 was associated with significantly better overall graft survival [adjusted hazard ratio (aHR) 0.83, 95% confidence interval (CI) 0.72-0.96] compared to single kidneys with KDRI >2.2. DKT was associated with significantly decreased odds of delayed graft function (top 2 KDRI categories) and significantly decreased odds of 1-year serum creatinine level >2 mg/dL (top 3 KDRI categories). Among SKT and DKT from KDRI >2.2 there were 16.1 and 13.9 graft losses per 100 patient follow-up years, respectively. KDRI >2.2 is a useful discriminatory cut-off for the determination of graft survival benefit with the use of DKT; however, the benefit of increased graft years was less than half of single kidneys from donors in the same KDRI range.
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Affiliation(s)
- T Klair
- Department of Surgery, Einstein College of Medicine, Bronx, NY
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Abstract
PURPOSE OF REVIEW To provide an up-to-date overview about the assessment of donor biopsies and to discuss the current problems and chances of preimplantation biopsies for transplant allocation with a focus on the technical work up and the histological variables scored. RECENT FINDINGS Preimplantation biopsy results are the major reason for discarding procured extended donor criteria kidneys in the USA. There is neither a consensus on the work up, nor the reporting of preimplantation donor biopsies, nor the importance of the biopsy findings in the process of allocation. The best available data have been collected in the context of single vs. double kidney transplantation. A clinical risk factor score may help to define kidneys when a preimplantation biopsy is warranted. Punch biopsies using a skin punch device appear to be a reasonable alternative for surgeons fearing needle biopsies. SUMMARY Donor biopsies are very useful as zero-hour biopsies establishing baseline information for comparison with subsequent transplant biopsies. As none of the histological variables and scores provides perfect prediction, preimplantation biopsy results have to be interpreted in the context of all available donor and recipient information.
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Clark MD, Leech D, Gumber A, Moro D, Szczepura A, West N, Higgins R. Who should be prioritized for renal transplantation?: Analysis of key stakeholder preferences using discrete choice experiments. BMC Nephrol 2012; 13:152. [PMID: 23173887 PMCID: PMC3576250 DOI: 10.1186/1471-2369-13-152] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 10/29/2012] [Indexed: 11/23/2022] Open
Abstract
Background Policies for allocating deceased donor kidneys have recently shifted from allocation based on Human Leucocyte Antigen (HLA) tissue matching in the UK and USA. Newer allocation algorithms incorporate waiting time as a primary factor, and in the UK, young adults are also favoured. However, there is little contemporary UK research on the views of stakeholders in the transplant process to inform future allocation policy. This research project aimed to address this issue. Methods Discrete Choice Experiment (DCE) questionnaires were used to establish priorities for kidney transplantation among different stakeholder groups in the UK. Questionnaires were targeted at patients, carers, donors / relatives of deceased donors, and healthcare professionals. Attributes considered included: waiting time; donor-recipient HLA match; whether a recipient had dependents; diseases affecting life expectancy; and diseases affecting quality of life. Results Responses were obtained from 908 patients (including 98 ethnic minorities); 41 carers; 48 donors / relatives of deceased donors; and 113 healthcare professionals. The patient group demonstrated statistically different preferences for every attribute (i.e. significantly different from zero) so implying that changes in given attributes affected preferences, except when prioritizing those with no rather than moderate diseases affecting quality of life. The attributes valued highly related to waiting time, tissue match, prioritizing those with dependents, and prioritizing those with moderate rather than severe diseases affecting life expectancy. Some preferences differed between healthcare professionals and patients, and ethnic minority and non-ethnic minority patients. Only non-ethnic minority patients and healthcare professionals clearly prioritized those with better tissue matches. Conclusions Our econometric results are broadly supportive of the 2006 shift in UK transplant policy which emphasized prioritizing the young and long waiters. However, our findings suggest the need for a further review in the light of observed differences in preferences amongst ethnic minorities, and also because those with dependents may be a further priority.
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Affiliation(s)
- Michael D Clark
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
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