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Marletta S, Di Bella C, Catalano G, Mastrosimini MG, Becker J, Ernst A, Rizzo PC, Caldonazzi N, Vasuri F, Malvi D, Fanelli GN, Naccarato G, Ghimenton C, L'Imperio V, Mescoli C, Eccher A, Furian L, Pagni F. Pre-Implantation Kidney Biopsies in Extended Criteria Donors: From On Call to Expert Pathologist, from Conventional Microscope to Digital Pathology. Crit Rev Oncog 2023; 28:7-20. [PMID: 37968988 DOI: 10.1615/critrevoncog.2023049007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
The number of patients awaiting a kidney transplant is constantly rising but lack of organs leads kidneys from extended criteria donors (ECD) to be used to increase the donor pool. Pre-transplant biopsies are routinely evaluated through the Karpinski-Remuzzi score but consensus on its correlation with graft survival is controversial. This study aims to test a new diagnostic model relying on digital pathology to evaluate pre-transplant biopsies and to correlate it with graft outcomes. Pre-transplant biopsies from 78 ECD utilized as single kidney transplantation were scanned, converted to whole-slide images (WSIs), and reassessed by two expert nephropathologists using the Remuzzi-Karpinski score. The correlation between graft survival at 36 months median follow-up and parameters assigned by either WSI or glass slide score (GSL) by on-call pathologists was evaluated, as well as the agreement between the GSL and the WSIs score. No relation was found between the GSL assessed by on-call pathologists and graft survival (P = 0.413). Conversely, the WSI score assigned by the two nephropathologists strongly correlated with graft loss probability, as confirmed by the ROC curves analysis (DeLong test P = 0.046). Digital pathology allows to share expertise in the transplant urgent setting, ensuring higher accuracy and favoring standardization of the process. Its employment may significantly increase the predictive capability of the pre-transplant biopsy evaluation for ECD, improving the quality of allocation and patient safety.
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Affiliation(s)
- Stefano Marletta
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy; Division of Pathology Humanitas Cancer Center, Catania, Italy
| | - Caterina Di Bella
- Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova
| | - Giovanni Catalano
- Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova
| | - Maria Gaia Mastrosimini
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Jan Becker
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Paola Chiara Rizzo
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Nicolo Caldonazzi
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Francesco Vasuri
- Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Deborah Malvi
- Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giuseppe Nicolo Fanelli
- Division of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giuseppe Naccarato
- Division of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Claudio Ghimenton
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Vincenzo L'Imperio
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Fondazione San Gerardo dei Tintori, Monza, Italy
| | - Claudia Mescoli
- Department of Medicine, Surgical Pathology and Cytopathology Unit, University of Padua, Padua, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Lucrezia Furian
- Department of Medicine, Surgical Pathology and Cytopathology Unit, University of Padua, Padua, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Fondazione San Gerardo dei Tintori, Monza, Italy
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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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Pavanello S, Campisi M, Rigotti P, Bello MD, Nuzzolese E, Neri F, Furian L. DNA Methylation - and Telomere - Based Biological Age Estimation as Markers of Biological Aging in Donors Kidneys. Front Med (Lausanne) 2022; 9:832411. [PMID: 35402460 PMCID: PMC8984253 DOI: 10.3389/fmed.2022.832411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
The biological age of an organ may represent a valuable tool for assessing its quality, especially in the elder. We examined the biological age of the kidneys [right (RK) and left kidney (LK)] and blood leukocytes in the same subject and compared these to assess whether blood mirrors kidney biological aging. Biological age was studied in n = 36 donors (median age: 72 years, range: 19-92; male: 42%) by exploring mitotic and non-mitotic pathways, using telomere length (TL) and age-methylation changes (DNAmAge) and its acceleration (AgeAcc). RK and LK DNAmAge are older than blood DNAmAge (RK vs. Blood, p = 0.0271 and LK vs. Blood, p = 0.0245) and RK and LK AgeAcc present higher score (this mean the AgeAcc is faster) than that of blood leukocytes (p = 0.0271 and p = 0.0245) in the same donor. TL of RK and LK are instead longer than that of blood (p = 0.0011 and p = 0.0098) and the increase in Remuzzi-Karpinski score is strongly correlated with kidney TL attrition (p = 0.0046). Finally, blood and kidney TL (p < 0.01) and DNAmAge (p < 0.001) were correlated. These markers can be evaluated in further studies as indicators of biological age of donor organ quality and increase the usage of organs from donors of advanced age therefore offering a potential translational research inkidney transplantation.
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Affiliation(s)
- Sofia Pavanello
- Occupational Medicine, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | - Manuela Campisi
- Occupational Medicine, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | - Paolo Rigotti
- Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padova, Italy
| | - Marianna Di Bello
- Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padova, Italy
| | - Erica Nuzzolese
- Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padova, Italy
| | - Flavia Neri
- Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padova, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padova, Italy
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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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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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Savoye E, Legendre C, Neuzillet Y, Peraldi MN, Grimbert P, Ouali N, Durand M, Badet L, Kerbaul F, Pastural M, Legeai C, Macher MA, Snanoudj R. Long-term survival benefit from dual kidney transplantation using kidneys from donors with very extended criteria - A French cohort between 2002 and 2014. Nephrol Dial Transplant 2021; 37:982-990. [PMID: 34748014 DOI: 10.1093/ndt/gfab317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This national multicenter retrospective cohort study aimed to assess the long-term outcomes of dual kidney transplantation (DKT) and compare them with those obtained from single kidney transplantation (SKT). METHODS Our first analysis concerned all first transplants performed between May 2002 and December 2014, from marginal donors, defined as brain death donors older than 65, with an estimated glomerular filtration rate (eGFR) lower than 90 ml/min/1.73m². The second analysis was restricted to transplants adequately allocated according to the French DKT program based on donor eGFR: DKT for eGFR between 30 and 60, SKT for eGFR between 60 and 90 ml/min/1.73m². Recipients younger than 65 years or with a panel-reactive antibody percentage ≥ 25% were excluded. RESULTS The first analysis included 461 DKT and 1131 SKT. DKT donors were significantly older (77.6 versus 74 years), had a more frequent history of hypertension and a lower eGFR (55.1 versus 63.6 ml/min/1.73m²). While primary nonfunction and delayed graft function did not differ between SKT and DKT, 1-year eGFR was lower in SKT recipients (39 vs. 49 ml/min/1.73m², P < 0.001). Graft survival was significantly better in DKT, even after adjustment for recipient and donor risk factors. Nevertheless, patient survival did not differ between these groups. The second analysis included 293 DKT and 687 SKT adequately allocated with donor eGFR and displayed similar results but with a smaller benefit in terms of graft survival. CONCLUSIONS In a context of organ shortage, DKT is a good option for optimizing the use of kidneys from very expanded criteria donors.
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Affiliation(s)
- Emilie Savoye
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Yann Neuzillet
- Service d'Urologie et de Transplantation Rénale, Hôpital Foch, Université de Versailles - Saint-Quentin-en-Yvelines, Suresnes, France
| | - Marie-Noëlle Peraldi
- Service de Néphrologie et Transplantation rénale, Hôpital Saint-Louis et Université de Paris, Paris, France
| | - Philippe Grimbert
- Nephrology and Renal Transplantation, CHU Henri Mondor and Paris Est University, Créteil, France
- Inserm U955, Créteil, France
| | - Nacera Ouali
- Service des Urgences Néphrologiques et Transplantation Rénale (UNTR), Hôpital Tenon, Paris, France
| | - Matthieu Durand
- Service d'Urologie, Andrologie, Transplantation Rénale, Hôpital Pasteur 2, Nice, France
- INSERM U1081 - CNRS UMR 7284, Université de Nice Côte d'Azur, Nice, France
| | - Lionel Badet
- Groupement Hospitalier Edouard Herriot, Service d'urologie chirurgie de la transplantation, Lyon, France
| | - François Kerbaul
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Myriam Pastural
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Camille Legeai
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Marie-Alice Macher
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Renaud Snanoudj
- Kremlin-Bicêtre Hospital, Paris, France
- Centre de recherche en Epidémiologie et Santé des Populations, INSERM U1018, Villejuif, France
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Odaldi F, Serenari M, Comai G, La Manna G, Bova R, Frascaroli G, Malvi D, Maroni L, Vasuri F, Germinario G, Baraldi O, Capelli I, Cuna V, Sangiorgi G, D'Errico A, Del Gaudio M, Bertuzzo VR, Zanfi C, Sessa M, Ravaioli M. The Relationship between Timing of Pretransplant Kidney Biopsy, Graft Loss, and Survival in Kidney Transplantation: An Italian Cohort Study. Nephron Clin Pract 2021; 146:22-31. [PMID: 34818242 DOI: 10.1159/000518610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Kidney biopsy is performed to assess if an extended criteria graft can be used for transplantation. It may be performed before or after cross-clamping during organ procurement. This study aims to evaluate whether the timing of biopsy may modify cold ischemia times (CIT) and/or graft outcomes. METHODS Kidney transplants performed in our center from January 2007 to December 2017 were analyzed. Grafts with preimplantation kidney biopsy were included. Biopsies were performed during surgical back table (ex situ kidney biopsy [ESKB]) until 2012 and since then before the aortic cross-clamping (in situ kidney biopsy [ISKB]). To overcome biases owing to different distributions, a propensity score model was developed. The study population consists in 322 patients, 115 ESKB, and 207 ISKB. RESULTS CIT was significantly lower for ISKB (730 min ISKB vs. 840 min ESKB, p value = 0.001). In both crude (OR 0.27; 95% confidence interval, 95% CI 0.12-0.60; p value = 0.002) and adjusted analyses (OR 0.37; 95% CI 0.14-0.94; p value = 0.039), ISKB was associated with a reduced odd of graft loss when compared to ESKB. DISCUSSION/CONCLUSION Performing preimplantation kidney biopsy during the recovery, prior to the aortic cross-clamping, may be a strategy to reduce CIT and improve transplant outcomes.
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Affiliation(s)
- Federica Odaldi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Serenari
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Raffaele Bova
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giacomo Frascaroli
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Deborah Malvi
- Department of Specialized, Experimental and Diagnostic Medicine, Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Maroni
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesco Vasuri
- Department of Specialized, Experimental and Diagnostic Medicine, Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giuliana Germinario
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Olga Baraldi
- Department of Experimental Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vania Cuna
- Department of Experimental Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gabriela Sangiorgi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonietta D'Errico
- Department of Specialized, Experimental and Diagnostic Medicine, Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Massimo Del Gaudio
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valentina Rosa Bertuzzo
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Chiara Zanfi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Matteo Ravaioli
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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8
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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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9
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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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10
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Initial experience with minimal incision dual kidney transplantation. Am J Surg 2021; 221:913-917. [DOI: 10.1016/j.amjsurg.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/11/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022]
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11
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Yap YT, Ho QY, Kee T, Ng CY, Chionh CY. Impact of pre-transplant biopsy on 5-year outcomes of expanded criteria donor kidney transplantation. Nephrology (Carlton) 2020; 26:70-77. [PMID: 32986301 DOI: 10.1111/nep.13788] [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: 08/10/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 01/09/2023]
Abstract
AIM Compared to Standard Criteria Donors (SCD), Expanded Criteria Donor (ECD) kidneys are associated with poorer outcomes, although pre-transplant biopsy may mitigate risks. This study assessed 5-year outcomes of deceased-donor kidney transplant recipients, comparing recipients of ECD allografts evaluated histologically to recipients of SCD and ECD kidneys assessed clinically. METHODS This is a single-centre retrospective study. From November 2005 to December 2009 (Era 1), donors were assessed clinically for suitability for kidney donation. From December 2009 to October 2017 (Era 2), kidneys from ECDs and diabetics underwent pre-transplant biopsy and were allocated based on Remuzzi score. Outcomes of Era 1 and 2 recipients were compared. RESULTS ECD kidney transplantation increased from 30.4% to 40.0% from Era 1 to 2. Univariable Cox regression, stratified by transplant era, found that 5-year graft loss was highest with Era 1 ECD (HR 2.5, 95% CI 1.1-5.5, P = .027) while graft loss for Era 2 ECD recipients was similar to SCD recipients. There was no difference in 5-year recipient survival. Amongst Era 1 ECD recipients, 51.2% experienced rejection compared to 30.8-41.5% for other subgroups. Five-year eGFR was higher with Era 2 ECD at 48.4 (33.3-60.7) ml/min/1.73 m2 compared to 42.2 (35.8-57.3) ml/min/1.73 m2 for Era 1 ECD. However, these differences were not statistically significant. CONCLUSION Introduction of pre-transplant biopsy assessment may be associated with improved outcomes of ECD kidney recipients such that they are now comparable to SCD kidney recipients, with benefits persisting over 5 years.
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Affiliation(s)
- Yun Ting Yap
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Quan Yao Ho
- Department of Renal Medicine, Singapore General Hospital, Singapore.,Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Terence Kee
- Department of Renal Medicine, Singapore General Hospital, Singapore.,Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Chee Yong Ng
- Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore.,Department of Renal Medicine, Changi General Hospital, Singapore
| | - Chang Yin Chionh
- Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore.,Department of Renal Medicine, Changi General Hospital, Singapore
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12
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Ibrahim M, Greenhall GHB, Summers DM, Mumford L, Johnson R, Baker RJ, Forsythe J, Pettigrew GJ, Ahmad N, Callaghan CJ. Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom. Clin J Am Soc Nephrol 2020; 15:1320-1329. [PMID: 32690721 PMCID: PMC7480543 DOI: 10.2215/cjn.02060220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidneys from elderly deceased donors are often discarded after procurement if the expected outcomes from single kidney transplantation are considered unacceptable. An alternative is to consider them for dual kidney transplantation. We aimed to examine the utilization of kidneys from donors aged ≥60 years in the United Kingdom and compare clinical outcomes of dual versus single kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the United Kingdom Transplant Registry from 2005 to 2017 were analyzed. We examined utilization rates of kidneys retrieved from deceased donors aged ≥60 years, and 5-year patient and death-censored graft survival of recipients of dual and single kidney transplants. Secondary outcomes included eGFR. Multivariable analyses and propensity score analysis were used to correct for differences between the groups. RESULTS During the study period, 7841 kidneys were procured from deceased donors aged ≥60 years, of which 1338 (17%) were discarded; 356 dual and 5032 single kidneys were transplanted. Donors of dual transplants were older (median, 73 versus 66 years; P<0.001) and had higher United States Kidney Donor Risk Indices (2.48 versus 1.98; P<0.001). Recipients of dual transplants were also older (64 versus 61 years; P<0.001) and had less favorable human leukocyte antigen matching (P<0.001). After adjusting for confounders, dual and single transplants had similar 5-year graft survival (hazard ratio, 0.81; 95% CI, 0.59 to 1.12). No difference in patient survival was demonstrated. Similar findings were observed in a matched cohort with a propensity score analysis method. Median 12-month eGFR was significantly higher in the dual kidney transplant group (40 versus 36 ml/min per 1.73 m2; P<0.001). CONCLUSIONS Recipients of kidneys from donors aged ≥60 years have similar 5-year graft survival and better graft function at 12 months with dual compared with single deceased donor kidney transplants.
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Affiliation(s)
- Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom .,National Health Service Blood and Transplant, Bristol, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - George H B Greenhall
- Department of Nephrology and Transplantation, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.,National Health Service Blood and Transplant, Bristol, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Dominic M Summers
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Lisa Mumford
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Rachel Johnson
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Richard J Baker
- Department of Nephrology, St James's University Hospital, The Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - John Forsythe
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Gavin J Pettigrew
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Niaz Ahmad
- Department of Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Chris J Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.,National Health Service Blood and Transplant, Bristol, United Kingdom
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13
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Petrara MR, Serraino D, Di Bella C, Neri F, Del Bianco P, Brutti M, Carmona F, Ballin G, Zanini S, Rigotti P, Furian L, De Rossi A. Immune activation, immune senescence and levels of Epstein Barr Virus in kidney transplant patients: Impact of mTOR inhibitors. Cancer Lett 2020; 469:323-331. [DOI: 10.1016/j.canlet.2019.10.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 12/19/2022]
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14
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15
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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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16
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Merzeau N, Champy C, Such M, Klapp J, Chahwan C, Vordos D, Hoznek A, Matignon M, Grimbert P, de la Taille A, Salomon L. [Evaluation of single kidney graft outcome in patients initially programmed for a dual kidney graft transplantation]. Prog Urol 2019; 29:340-346. [PMID: 31151914 DOI: 10.1016/j.purol.2019.04.003] [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: 06/25/2018] [Revised: 02/16/2019] [Accepted: 04/18/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Kidney transplantation is championed as the gold standard treatment for patients with end-stage kidney disease. According to the biomedical agency, there is an increasing number of patients waiting for kidney transplantation. Faced with organ shortage, the use of marginal grafts may well increase the number of available kidney grafts. Occasionally, during dual kidney graft transplantation, the poor quality of one of the two grafts, or other specific circumstances, may lead to transplantation of only one of the two grafts. We have compared patient outcome concerning single kidney transplantation from an initial dual kidney graft with respect to dual kidney graft transplantation. MATERIAL Among 67 patients enrolled for a dual kidney graft, 39 dual kidney grafts (group 1) were compared with 12 grafts performed with only one of the two kidneys of a dual kidney graft (group 2) as well as 15 grafts performed following a classic kidney graft protocol (group 3). RESULTS The survival of grafts was respectively for groups 1, 2 and 3 of 100%, 72,5% and 75,4% (P=0.17). The survival of patients was respectively for groups 1, 2 and 3 of 78.3%, 89.9% and 87.8% (P=0.47). CONCLUSION Our study suggests that transplantation of a single kidney, initially proposed as dual kidney graft candidate, has satisfying results in terms of graft survival and patient mortality at the expense of poorer renal function in comparison to dual kidney graft. Indeed, there was no significant difference in the survival of patients and grafts. This seems promising taking into consideration that the aim of transplantation in elderly recipients is primarily to avoid dialysis, rather than having optimal post-transplantation kidney function. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- N Merzeau
- Service d'urologie, hôpital Robert-Debré, rue du Général-Koenig, 51092 Reims cedex, France.
| | - C Champy
- Service d'urologie, hôpital Henri-Mondor, 51, avenue du Ml de Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - M Such
- Service d'urologie, hôpital Henri-Mondor, 51, avenue du Ml de Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - J Klapp
- Service d'urologie, hôpital Henri-Mondor, 51, avenue du Ml de Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - C Chahwan
- Service d'urologie, hôpital Henri-Mondor, 51, avenue du Ml de Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - D Vordos
- Service d'urologie, hôpital Henri-Mondor, 51, avenue du Ml de Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - A Hoznek
- Service d'urologie, hôpital Henri-Mondor, 51, avenue du Ml de Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - M Matignon
- Service de néphrologie, hôpital Henri-Mondor, 51, avenue du Ml de Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - P Grimbert
- Service de néphrologie, hôpital Henri-Mondor, 51, avenue du Ml de Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - A de la Taille
- Service d'urologie, hôpital Henri-Mondor, 51, avenue du Ml de Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - L Salomon
- Service d'urologie, hôpital Henri-Mondor, 51, avenue du Ml de Lattre-de-Tassigny, 94010 Créteil cedex, France
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17
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Rogers J, Farney AC, Orlando G, Harriman D, Reeves-Daniel A, Jay CL, Doares W, Kaczmorski S, Gautreaux MD, Stratta RJ. Dual Kidney Transplantation from Donors at the Extremes of Age. J Am Coll Surg 2019; 228:690-705. [PMID: 30630083 DOI: 10.1016/j.jamcollsurg.2018.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The study purpose was to analyze outcomes in recipients of pediatric dual en bloc (PEB) kidneys from small pediatric donors (SPDs, age ≤ 3 years) and dual kidney transplants (KTs) from adult marginal deceased donors (DDs) in the context of the Kidney Donor Profile Index (KDPI). STUDY DESIGN This was a single center retrospective review. Recipient selection included primary transplant, low BMI, low immunologic risk, and informed consent. All patients received antibody induction with FK/MPA/± prednisone. RESULTS From 2002 to 2015, we performed 34 PEB and 73 adult dual KTs. Mean donor ages were 17 months for the PEB and 59 years for the dual KTs; mean KDPIs were 73% for PEB and 83% for dual KT, and mean cold ischemia times were 21.0 hours for PEB and 26.5 hours for dual KT. Adult dual KT recipients were older (mean age 38 years for PEB and 60 years for dual KT) and had shorter waiting times (mean 25 months for PEB and 12 months for dual KT). With a mean follow-up of 7.6 years, actual patient survival (88% for PEB and 62% for dual KT) and graft survival (71% for PEB and 44% for dual KT) rates were higher in PEB compared with dual KT. Death-censored kidney graft survival rates were 77% for PEB and 58% for dual KT. Delayed graft function (DGF) rates were 15% for PEB and 23% for dual KT; incidences of DGF in single kidney transplantations from SPDs and adult nonmarginal DDs were 20% and 32%, respectively. Based on actual 5-year graft survival rates, the adjusted KDPIs for dual PEB and dual KTs were 3% and 60%, respectively. CONCLUSIONS Acceptable mid-term outcomes are associated with PEB and adult dual KTs, which may expand the donor pool and prevent kidney discard. The KDPI is inaccurate for predicting outcomes from either PEB from SPDs or dual KT from adult marginal DDs, which may prevent acceptance of these organs.
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Affiliation(s)
- Jeffrey Rogers
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alan C Farney
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Giuseppe Orlando
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - David Harriman
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amber Reeves-Daniel
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Colleen L Jay
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - William Doares
- Department of Pharmacy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Scott Kaczmorski
- Department of Pharmacy, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Robert J Stratta
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC.
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18
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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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19
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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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20
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Ruggenenti P, Silvestre C, Boschiero L, Rota G, Furian L, Perna A, Rossini G, Remuzzi G, Rigotti P. Long-term outcome of renal transplantation from octogenarian donors: A multicenter controlled study. Am J Transplant 2017; 17:3159-3171. [PMID: 28792681 DOI: 10.1111/ajt.14459] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/11/2017] [Accepted: 08/01/2017] [Indexed: 02/06/2023]
Abstract
To assess whether biopsy-guided selection of kidneys from very old brain-dead donors enables more successful transplantations, the authors of this multicenter, observational study compared graft survival between 37 recipients of 1 or 2 histologically evaluated kidneys from donors older than 80 years and 198 reference-recipients of non-histologically evaluated single grafts from donors aged 60 years and younger (transplantation period: 2006-2013 at 3 Italian centers). During a median (interquartile range) of 25 (13-42) months, 2 recipients (5.4%) and 10 reference-recipients (5.1%) required dialysis (crude and donor age- and sex-adjusted hazard ratio [95% confidence interval] 1.55 [0.34-7.12], P = .576 and 1.41 [0.10-19.54], P = .798, respectively). Shared frailty analyses confirmed similar outcomes in a 1:2 propensity score study comparing recipients with 74 reference-recipients matched by center, year, donor, and recipient sex and age. Serum creatinine was similar across groups during 84-month follow-up. Recipients had remarkably shorter waiting times than did reference-recipients and matched reference-recipients (7.5 [4.0-19.5] vs 36 [19-56] and 40 [24-56] months, respectively, P < .0001 for both comparisons). Mean (± SD) kidney donor risk index was 2.57 ± 0.32 in recipients vs 1.09 ± 0.24 and 1.14 ± 0.24 in reference-recipients and matched reference-recipients (P < .0001 for both comparisons). Adverse events were similar across groups. Biopsy-guided allocation of kidneys from octogenarian donors permits further expansion of the donor organ pool and faster access to a kidney transplant, without increasing the risk of premature graft failure.
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Affiliation(s)
- Piero Ruggenenti
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Diseases Aldo e Cele Daccò, Bergamo, Italy.,Nephrology and Dialysis Unit, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Cristina Silvestre
- Kidney and Pancreas Transplant Unit, University Hospital of Padua, Padua, Italy
| | - Luigino Boschiero
- Kidney Transplantation Unit, Department of Surgery, Azienda Ospedaliero-Universitaria (AOUI) di Verona, Verona, Italy
| | - Giovanni Rota
- Kidney Transplantation Center, Unit of Pediatric Surgery, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplant Unit, University Hospital of Padua, Padua, Italy
| | - Annalisa Perna
- Nephrology and Dialysis Unit, 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
| | - Giuseppe Remuzzi
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center 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
| | - Paolo Rigotti
- Kidney and Pancreas Transplant Unit, University Hospital of Padua, Padua, Italy
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21
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Neri F, Furian L, Cavallin F, Ravaioli M, Silvestre C, Donato P, La Manna G, Pinna AD, Rigotti P. How does age affect the outcome of kidney transplantation in elderly recipients? Clin Transplant 2017. [DOI: 10.1111/ctr.13036/?url=http://interact.sh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Flavia Neri
- Kidney and Pancreas Transplant Unit Department of Surgery, Oncology and Gastroenterology Padua University Hospital Padua Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplant Unit Department of Surgery, Oncology and Gastroenterology Padua University Hospital Padua Italy
| | - Francesco Cavallin
- Esophageal and Digestive Tract Surgical Unit Veneto Institute of Oncology IOV IRCCS Padua Italy
| | - Matteo Ravaioli
- General Surgery and Transplant Unit Department of Medical and Surgical Sciences S. Orsola‐Malpighi Hospital University of Bologna Bologna Italy
| | - Cristina Silvestre
- Kidney and Pancreas Transplant Unit Department of Surgery, Oncology and Gastroenterology Padua University Hospital Padua Italy
| | - Paola Donato
- Kidney and Pancreas Transplant Unit Department of Surgery, Oncology and Gastroenterology Padua University Hospital Padua Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplant Unit S. Orsola‐Malpighi Hospital University of Bologna Bologna Italy
| | - Antonio Daniele Pinna
- General Surgery and Transplant Unit Department of Medical and Surgical Sciences S. Orsola‐Malpighi Hospital University of Bologna Bologna Italy
| | - Paolo Rigotti
- Kidney and Pancreas Transplant Unit Department of Surgery, Oncology and Gastroenterology Padua University Hospital Padua Italy
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22
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Neri F, Furian L, Cavallin F, Ravaioli M, Silvestre C, Donato P, La Manna G, Pinna AD, Rigotti P. How does age affect the outcome of kidney transplantation in elderly recipients? Clin Transplant 2017. [PMID: 28640530 DOI: 10.1111/ctr.13036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aging of the on-dialysis population raises the issue of whether to propose elderly patients for kidney transplantation and how to manage their immunosuppression. This study aimed to analyze the outcome of kidney transplantation on an Italian series of elderly recipients. We included in this retrospective study all patients over 60 years, receiving a deceased-donor kidney transplantation from January 2004 to December 2014 in two north Italian Centers. We analyzed the correlation of recipient age with graft's and patient's survival, delayed graft function, acute cellular rejection (ACR), surgical complications, infections, and glomerular filtration rate. Four hundred and fifty-two patients with a median age of 65 years were included in the study. One-, 3-, and 5-year patient's and graft's survival were, respectively, of 98.7%, 93%, 89% and 94.4%, 87.9%, 81.4%. The increasing recipient age was an independent risk factor only for the patient's (P=.008) and graft's survival (P=.002). ACR and neoplasia were also associated to a worse graft survival. The reduced graft survival in elderly kidney recipients seems to be related more to the increasing recipient's age than to the donor's features. In this population, the optimization of organ allocation and immunosuppression may be the key factors to endorse improvements.
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Affiliation(s)
- Flavia Neri
- Kidney and Pancreas Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Francesco Cavallin
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
| | - Matteo Ravaioli
- General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cristina Silvestre
- Kidney and Pancreas Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Paola Donato
- Kidney and Pancreas Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Daniele Pinna
- General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Rigotti
- Kidney and Pancreas Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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Jozwik A, Domagala P, Kieszek R, Wszola M, Serwanska-Swietek M, Karpeta E, Gorski L, Bieniasz M, Jonas M, Berman A, Paczek L, Durlik M, Chmura A, Kwiatkowski A. Renal Transplantation Using Kidneys Procured From Elderly Donors Older Than 70 Years. Transplant Proc 2017; 48:1477-81. [PMID: 27496431 DOI: 10.1016/j.transproceed.2016.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/24/2016] [Accepted: 03/08/2016] [Indexed: 10/21/2022]
Abstract
AIM A major problem for the transplant society is a shortage of organs for transplantation compared with the number of patients on the waiting list. This study aimed to assess the results of the transplantation of kidneys procured from older donors. PATIENTS AND METHODS A total of 27 kidneys procured from donors age 70 years or older were transplanted between January 1, 2010, and April 25, 2015. These represented only 4.1% of the 657 kidneys transplanted from deceased donors during this period at the same center. RESULTS Delayed graft function (DGF) in the recipients of kidneys procured from donors age 70 or older occurred in 46.1% of patients, whereas the recipients of kidneys from younger donors showed DGF at a frequency of 32.7% (P = NS). The annual and 3-year survival rates of kidneys in the study group were 85% and 80%, respectively, and in the control group were 92.5% and 88.6%, respectively (P = NS). According to the Polish National Organ Procurement Organization (Poltransplant), the annual survival rate of a transplanted kidney in Poland stands at 89%, whereas the 3-year survival rate is 82%. We detected no significant posttransplantation differences in the serum creatinine concentration and in the estimated glomerular filtration rate between the study and control groups. The donor age and donor creatinine were the variables independently associated with DGF. CONCLUSIONS The results of transplantation of kidneys from elderly donors were comparable to those of transplantation from younger donors. Kidneys harvested from elderly donors should be used for a transplant after a preliminary assessment.
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Affiliation(s)
- A Jozwik
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - P Domagala
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland.
| | - R Kieszek
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - M Wszola
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - M Serwanska-Swietek
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - E Karpeta
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - L Gorski
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - M Bieniasz
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - M Jonas
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - A Berman
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - L Paczek
- Departments of Immunology, Transplantology, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Departments of Transplantology and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - A Chmura
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - A Kwiatkowski
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
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Ekser B, Silvestre C, Furian L. Combined liver-dual kidney transplant: Role in expanded donors. Liver Transpl 2017; 23:266-267. [PMID: 27783463 DOI: 10.1002/lt.24665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/06/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Burcin Ekser
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Cristina Silvestre
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
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Di Laudo M, Ravaioli M, La Manna G, Comai G, Cescon M, Del Gaudio M, Zanfi C, Cucchetti A, Ercolani G, Pinna AD. Combined liver-dual kidney transplant: Role in expanded donors. Liver Transpl 2017; 23:28-34. [PMID: 27113672 DOI: 10.1002/lt.24472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 04/14/2016] [Indexed: 12/24/2022]
Abstract
Kidney injury is a common clinical feature among liver transplantation (LT) candidates that heavily affects prognosis and complicates the surgical decision-making process. Up to 20% of patients undergoing LT demonstrate some degree of renal impairment, and 2% will benefit from a combined liver-kidney transplantation (LKT). We present a case-control study of all patients who underwent LKT and combined liver-dual kidney transplantation (LDKT) from November 2013 to March 2016. For the selection of LDKT candidates, a histological-based algorithm was applied: when evaluating extended criteria donors (ECDs), with any Remuzzi score between 4 and 7, we would consider performing a LDKT instead of a simple LKT. Study groups were similar for recipient variables. In the LDKT group, donor age, donor risk index, and donor body mass index were found to be significantly higher. Biopsies obtained from all pairs of kidney grafts in the LDKT group demonstrated the following Remuzzi scores: 4+4, 4+4, 7+1, 4+5. Despite longer operative times for the LDKT procedure, no differences were observed regarding the main investigated outcome parameters. Overall survival was 100% (LDKT) and 91% (LKT, P > 0.99). This is a preliminary experience which might indicate that LDKT is a safe, feasible, and resource-effective technique. The evaluation of a larger cohort, as well as the experience from other centers, would be needed to clearly identify its role in the ECD era. Liver Transplantation 23:28-34 2017 AASLD.
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Affiliation(s)
- Marco Di Laudo
- Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Matteo Ravaioli
- Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Gaetano La Manna
- Department of Nephrology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giorgia Comai
- Department of Nephrology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Matteo Cescon
- Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Massimo Del Gaudio
- Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Chiara Zanfi
- Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alessandro Cucchetti
- Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giorgio Ercolani
- Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Antonio Daniele Pinna
- Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
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La transplantation rénale et ses défis. Prog Urol 2016; 26:1001-1044. [PMID: 27720627 DOI: 10.1016/j.purol.2016.09.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 01/09/2023]
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Stratta RJ, Farney AC, Orlando G, Farooq U, Al-Shraideh Y, Palanisamy A, Reeves-Daniel A, Doares W, Kaczmorski S, Gautreaux MD, Iskandar SS, Hairston G, Brim E, Mangus M, El-Hennawy H, Khan M, Rogers J. Dual kidney transplants from adult marginal donors successfully expand the limited deceased donor organ pool. Clin Transplant 2016; 30:380-92. [PMID: 26782941 DOI: 10.1111/ctr.12697] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND The need to expand the organ donor pool remains a formidable challenge in kidney transplantation (KT). The use of expanded criteria donors (ECDs) represents one approach, but kidney discard rates are high because of concerns regarding overall quality. Dual KT (DKT) may reduce organ discard and optimize the use of kidneys from marginal donors. STUDY DESIGN We conducted a single-center retrospective review of outcomes in adult recipients of DKTs from adult marginal deceased donors (DD) defined by limited renal functional capacity. If the calculated creatinine clearance in an adult DD was <65 mL/min, then the kidneys were transplanted as a DKT. RESULTS Over 11.5 yr, 72 DKTS were performed including 45 from ECDs, 17 from donation after cardiac death (DCD) donors, and 10 from standard criteria donors (SCD). Mean adult DD and recipient ages were both 60 yr, including 29 DDs and 26 recipients ≥65 yr of age. Mean pre-DKT waiting and dialysis vintage times were 12 months and 25 months, respectively. Actual patient and graft survival rates were 84.7% and 70.8%, respectively, with a mean follow-up of 58 months. One yr and death-censored graft survival rates were 90% and 80%, respectively. Outcomes did not differ by DD category, recipient age, or presence of delayed graft function (DGF). Eleven patients died at a mean of 32 months post-DKT (eight with functioning grafts) and 13 other patients experienced graft losses at a mean of 33 months. The incidence of DGF was 25%; there were two cases (2.8%) of primary non-function. Mean length of initial hospital stay was 7.2 d. Mean serum creatinine and glomerular filtration rate levels at 12 and 24 months were 1.5 and 53 and 1.5 mg/dL and 51 mL/min/1.73 m(2) , respectively. DKT graft survival and function were superior to concurrent single ECD and similar to concurrent SCD KTs. Two patients underwent successful kidney retransplantation, so the dialysis-free rate in surviving patients was 87%. The proportion of total renal function transplanted from adult DD to DKT recipients was 77% compared to 56% for patients receiving single KTs. CONCLUSIONS Dual kidney transplantation using kidneys from adult marginal DDs that otherwise might be discarded offer a viable option to counteract the growing shortage of acceptable single kidneys. Excellent medium-term outcomes can be achieved and waiting times can be reduced in a predominantly older recipient population.
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Affiliation(s)
- Robert J Stratta
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alan C Farney
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Giuseppe Orlando
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Umar Farooq
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Yousef Al-Shraideh
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amudha Palanisamy
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amber Reeves-Daniel
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - William Doares
- Department of Pharmacy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott Kaczmorski
- Department of Pharmacy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael D Gautreaux
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Samy S Iskandar
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gloria Hairston
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elizabeth Brim
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Margaret Mangus
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hany El-Hennawy
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Muhammad Khan
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeffrey Rogers
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Eccher A, Neil D, Ciangherotti A, Cima L, Boschiero L, Martignoni G, Ghimenton C, Chilosi M, Giobelli L, Zampicinini L, Casartelli M, Brunelli M. Digital reporting of whole-slide images is safe and suitable for assessing organ quality in preimplantation renal biopsies. Hum Pathol 2015; 47:115-20. [PMID: 26547252 DOI: 10.1016/j.humpath.2015.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/24/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
Abstract
Digital pathology allows networks of "remote" specialist pathologists to report the findings of preimplantation kidney biopsies. We sought to validate the assessment of preimplantation kidney transplant biopsies for diagnostic purposes using whole-slide images according to the recommendations of the College of American Pathologists. Sixty-two consecutive, previously reported, preimplantation kidney biopsies were scanned using the ScanScope Digital Slide Scanner at 0.5 μm/pixel (20× objective). The slides were assessed for percent glomerulosclerosis, tubular atrophy, interstitial fibrosis and vascular narrowing using the Remuzzi criteria by two pathologists, one using glass slides and the other using the whole-slide images viewed on a widescreen computer monitor. After a 2-week washout period, all of the slides were re-assessed by the same pathologists using the opposite mode of reporting to that used in the first evaluation. Very high glass-digital intraobserver concordance was achieved for the overall score and for individual grades by both pathologists (κ range, 0.841-0.973). The overall scores obtained by both pathologists and using both methods were identical. The times needed to assess the biopsies were 14 minutes when using a light microscope and 18 minutes, including scanning time, which averaged 2 minutes 20 seconds per slide, when using digital microscopy. Digital microscopy is a reliable, fast, and safe method for the assessment of preimplantation kidney biopsies.
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Affiliation(s)
- Albino Eccher
- University and Hospital Trust, Pathology, Department of Diagnostics and Pathology, 37134, Verona, Italy.
| | - Desley Neil
- Queen Elizabeth Hospital Birmingham, Pathology, Department of Histopathology, B152GW, Birmingham, UK.
| | - Andrea Ciangherotti
- University and Hospital Trust, Division of General and Hepatobiliary Surgery, Department of Surgical Science, 37134, Verona, Italy.
| | - Luca Cima
- University and Hospital Trust, Pathology, Department of Diagnostics and Pathology, 37134, Verona, Italy.
| | - Luigino Boschiero
- University and Hospital Trust, Kidney Transplant Center, Department of Surgical Science, 37126, Verona, Italy.
| | - Guido Martignoni
- University and Hospital Trust, Pathology, Department of Diagnostics and Pathology, 37134, Verona, Italy.
| | - Claudio Ghimenton
- University and Hospital Trust, Pathology, Department of Diagnostics and Pathology, 37134, Verona, Italy.
| | - Marco Chilosi
- University and Hospital Trust, Pathology, Department of Diagnostics and Pathology, 37134, Verona, Italy.
| | - Luca Giobelli
- University and Hospital Trust, Department CED, 37134, Verona, Italy.
| | - Laura Zampicinini
- University and Hospital Trust, Neurosurgery and Intensive Care Unit, Department of Surgical Science, 37126, Verona, Italy.
| | - Marilena Casartelli
- University and Hospital Trust, Neurosurgery and Intensive Care Unit, Department of Surgical Science, 37126, Verona, Italy.
| | - Matteo Brunelli
- University and Hospital Trust, Pathology, Department of Diagnostics and Pathology, 37134, Verona, Italy.
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Rigotti P, Capovilla G, Di Bella C, Silvestre C, Donato P, Baldan N, Furian L. A single-center experience with 200 dual kidney transplantations. Clin Transplant 2014; 28:1433-40. [PMID: 25297945 DOI: 10.1111/ctr.12475] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 01/20/2023]
Abstract
This study reports on a large series of 200 dual kidney transplantations (DKTs) from expanded criteria donors (ECDs) and proposes specific ways to optimize outcomes. Data concerning 200 DKTs performed in the last 14 yr were retrospectively analyzed. Kidneys from high-risk ECD were allocated for use in DKTs on an old-for-old basis after histological assessment. Different surgical techniques and immunosuppressant regimens were used over time, and the outcomes are discussed. Donors and recipients were a median 73 (70-77) and a 62 (58-67) yr old, respectively. Delayed graft function occurred in 31.5% of cases, and acute rejection in 13.5%. Patient and graft survival at five yr were 90.4% and 85.8%, respectively. Unilateral kidney placement was preferred for 75% of patients, and was associated with a low rate of surgical complications. Our current standard therapy comprising low-dose calcineurin inhibitors (CNIs) associated with mammalian target of rapamycin inhibitors (mTOR) and steroids appears to offer the best risk/benefit profile for elderly patients undergoing DKT. In our experience, outcomes after DKT can be improved by: (i) kidney clinical-histological assessment; (ii) unilateral kidney placement; (iii) minimal use of CNI associated with mTOR.
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Affiliation(s)
- Paolo Rigotti
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, Padua University Hospital, University of Padua, Padua, Italy
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Abstract
PURPOSE OF REVIEW The current era of organ shortage has necessitated a widening of criteria for donation, considering donors who would have been considered unsuitable before. This review summarizes the recent advances in strategies to maximize the use of marginal kidneys without compromising the outcomes. RECENT FINDINGS Various strategies have been studied and implemented to optimize procurement and allocation of marginal kidneys, and to preserve their function. In particular, a growing number of transplant centers are using donors after circulatory death. Whereas normothermic ex-vivo and postmortem perfusion are promising procedures to improve the outcomes of marginal grafts in the future, dual-kidney transplantation is a viable approach which is at present potentially underutilized. Despite active research on new strategies to evaluate organ quality, pretransplant biopsy assessment currently remains the most reliable method. The practice of using living donors with advanced age is supported by available evidence, whereas the use of young living donors with minor medical abnormalities needs further investigation. SUMMARY Progress has been made in the recent years, clarifying the best criteria for evaluating, recovering, and allocating marginal kidney donors. However, further research is needed, with special regards to the criteria for using marginal living-kidney donors.
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Affiliation(s)
- Umberto Maggiore
- aTrapianti Rene-Pancreas (U.O.C. Nefrologia), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy bRenal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Maggiore U, Oberbauer R, Pascual J, Viklicky O, Dudley C, Budde K, Sorensen SS, Hazzan M, Klinger M, Abramowicz D. Strategies to increase the donor pool and access to kidney transplantation: an international perspective. Nephrol Dial Transplant 2014; 30:217-22. [PMID: 24907023 PMCID: PMC4309190 DOI: 10.1093/ndt/gfu212] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In this position article, DESCARTES (Developing Education Science and Care for Renal Transplantation in European States) board members describe the current strategies aimed at expanding living and deceased donor kidney pools. The article focuses on the recent progress in desensitization and kidney paired exchange programmes and on the expanded criteria for the use of donor kidneys and organs from donors after circulatory death. It also highlights differences in policies and practices across different regions with special regard to European Union countries. Living donor kidney paired exchange, the deceased donor Acceptable Mismatch Programme and kidneys from donors after circulatory death are probably the most promising innovations for expanding kidney transplantation in Europe over the coming decade. To maximize success, an effort is needed to standardize transplant strategies, policies and legislation across European countries.
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Affiliation(s)
- Umberto Maggiore
- Department of Nephrology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Rainer Oberbauer
- KH Elisabethinen Linz and Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Ondrej Viklicky
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Klemens Budde
- Department of Nephrology, Charité Medical University Berlin, Berlin, Germany
| | | | - Marc Hazzan
- Service de Néphrologie, Univ Lille Nord de France, Lille, France
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
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Assis-Borba L, Cristelli MP, Paula MI, Franco MF, Tedesco-Silva H, Medina-Pestana JO. Expanding the use of expanded criteria donors in kidney transplantation. Int Urol Nephrol 2014; 46:1663-71. [PMID: 24677001 DOI: 10.1007/s11255-014-0695-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 03/17/2014] [Indexed: 01/16/2023]
Abstract
PURPOSE Although the use of kidney allografts from expanded criteria donors (ECD) has increased in recent years, the reported discard rates are also growing. The influence of ECD characteristics on transplant outcomes is still underevaluated. METHODS This retrospective study investigated the influence of preimplantation biopsy findings and delayed graft function (DGF) on patient and graft survivals and renal function at 36 months in a cohort of 372 ECD kidney transplant recipients. RESULTS Patient and graft survivals were 91.6 and 68.9 %. The incidence of biopsy-proven acute rejection was 31 %. There were no differences in patient (88.6 vs. 91.1 vs. 94.7 vs. 78.6 %, p = 0.10) or graft (78.1 vs. 72.2 vs. 60.5 vs. 62.6 %, p = 0.14) survivals and renal function (41.7 ± 25.6 vs. 39.9 ± 29.9 vs. 38.1 ± 30.6 vs. 37.4 ± 29.2 mL/min, p = 0.79) comparing ECD kidneys with mild, moderate, and severe histological changes or with no preimplantation biopsy, respectively. However, severe scored transplants had the worst death-censored graft survival (OR 3.1, 95 % CI 1.4-6.9, p = 0.007). No significant differences in patient (86.2 vs. 83.4 %, p = 0.17) or graft (73.7 vs. 65.9 %, p = 0.06) survivals and renal function (38.9 ± 28.6 vs. 39.9 ± 28.4 mL/min, p = 0.72) were observed comparing patients with or without DGF. Multivariable analysis found diabetes history as the only independent risk factor for graft loss (OR 2.1, 95 % CI 1.3-3.3, p = 0.003) or patient death (OR 3.1, 95 % CI 1.5-5.8, p < 0.001). CONCLUSIONS Within the limitations of sample size and short follow-up time, in this cohort of ECD kidney transplant recipients the severity of histological changes observed in preimplantation biopsies was independently associated with graft loss.
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Affiliation(s)
- Luciana Assis-Borba
- Transplant Division, Hospital do Rim e Hipertensão, UNIFESP, São Paulo, SP, Brazil
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Corrigendum. Transpl Int 2013. [DOI: 10.1111/tri.12193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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