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Ntatsaki E, Velo-Garcia A, Vassiliou VS, Salama AD, Isenberg DA. Impact of pre-transplant time on dialysis on survival in patients with lupus nephritis. Clin Rheumatol 2018; 37:2399-2404. [PMID: 29748727 PMCID: PMC6097102 DOI: 10.1007/s10067-018-4115-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/02/2018] [Accepted: 04/17/2018] [Indexed: 11/25/2022]
Abstract
Lupus nephritis (LN) is an important cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE) often leading to end-stage renal failure (ESRF) and necessitating renal transplantation (rTp). Optimal timing of rTp in SLE patients with ESRF is uncertain and could potentially affect survival. We investigated the time spent on dialysis before rTp and survival following rTp in a cohort of SLE patients. Retrospective analysis of all adult SLE patients receiving rTp over a 40-year period (1975–2015) in two tertiary UK centres. Cox proportional hazard regression and receiver operator curves (ROC) were used to determine the risk associated with time on dialysis before rTp and other potential predictors. Forty patients (age 35 ± 11 years, 34 female, 15 Caucasian, 15 Afro–Caribbean and 10 South Asian) underwent rTp. During a median follow-up of 104 months (IQR 80,145), eight (20%) patients died and the 5-year survival was 95%. Univariate analysis identified time on dialysis prior to rTp as the only potentially modifiable risk predictor of survival with a hazard ratio of 1.013 for each additional month spent on dialysis (95% CI = 1.001–1.026, p = 0.03). ROC curves demonstrated that > 24 months on dialysis had an adverse effect with sensitivity of 0.875 and specificity 0.500 for death. No other modifiable predictors were significantly associated with mortality, indicating that time on dialysis had an independent effect. Increased time on dialysis pre-transplantation is an independent modifiable risk factor of mortality in this cohort of patients with lupus nephritis.
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Affiliation(s)
- Eleana Ntatsaki
- Centre for Rheumatology, Division of Medicine, University College London, 250 Euston Road, London, NW1 2PG, UK. .,Rheumatology Department, Ipswich Hospital, Heath Road, Ipswich, IP4 5PD, UK.
| | - Alba Velo-Garcia
- Centre for Rheumatology, Division of Medicine, University College London, 250 Euston Road, London, NW1 2PG, UK.,Internal Medicine Department, University Hospital Complex of Pontevedra, Pontevedra, Spain
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK.,Imperial College London, London, UK
| | - Alan D Salama
- Centre for Nephrology, University College London, London, UK
| | - David A Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, 250 Euston Road, London, NW1 2PG, UK
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Pieloch D, Dombrovskiy V, Osband AJ, DebRoy M, Mann RA, Fernandez S, Mondal Z, Laskow DA. The Kidney Transplant Morbidity Index (KTMI): A Simple Prognostic Tool to Help Determine Outcome Risk in Kidney Transplant Candidates. Prog Transplant 2015; 25:70-6. [DOI: 10.7182/pit2015462] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The Kidney Transplant Morbidity Index (KTMI) is a novel prognostic morbidity index to help determine the impact that pretransplant comorbid conditions have on transplant outcome. Objective To use national data to validate the KTMI. Design Retrospective analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing database. Setting and Participants The study sample consisted of 100 261 adult patients who received a kidney transplant between 2000 and 2008. Main Outcome Measure Kaplan-Meier survival curves were used to demonstrate 3-year graft and patient survival for each KTMI score. Cox proportional hazards regression models were created to determine hazards for 3-year graft failure and patient mortality for each KTMI score. Results A sequential decrease in graft survival (0 = 91.2%, 1 = 88.2%, 2 = 85.4%, 3 = 81.7%, 4 = 77.8%, 5 = 74.0%, 6 = 69.8%, and ≥7 = 68.7) and patient survival (0 = 98.2%, 1 = 96.6%, 2 = 93.7%, 3 = 89.7%, 4 = 84.8%, 5 = 80.8%, 6 = 76.0%, and ≥7 = 74.7%) is seen as KTMI scores increase. The differences in graft and patient survival between KTMI scores are all significant ( P < .001) except between 6 and ≥7. Multivariate regression analysis reveals that KTMI is an independent predictor of higher graft failure and patient mortality rates and that risk increases as KTMI scores increase. Conclusion The KTMI strongly predicts graft and patient survival by using pretransplant comorbid conditions; therefore, this easy-to-use tool can aid in determining outcome risk and transplant candidacy before listing, particularly in candidates with multiple comorbid conditions.
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Affiliation(s)
- Daniel Pieloch
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - Viktor Dombrovskiy
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - Adena J. Osband
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - Meelie DebRoy
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - Richard A. Mann
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - Sonalis Fernandez
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - Zahidul Mondal
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - David A. Laskow
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
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West JC, Chao S, Kelley SE, Schwartz JA, Bertsch DJ, Marsh JF. Organ allocation: a case for not transplanting the violent criminal. Semin Dial 2003; 16:362-4. [PMID: 12969382 DOI: 10.1046/j.1525-139x.2003.16073.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As organ transplantation outcomes become ever more successful, vigilance as to appropriate recipient selection must be ensured, for without careful monitoring the already great disparity between organ supply and demand will continue to grow. There is a public perception that justice requires equal access to treatment for all, but this is not always the case. We suggest that, while violent felons do not account for a large number of transplant recipients, transplanting even one such individual should be deemed inadvisable-and could well be fraught with irreparable public repercussions.
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Vianello A, Padoan MV, Calconi G, Chiara G, D'Annibale A, Maresca MC. Influence of length of time on dialysis before grafting on kidney transplant results. Ren Fail 1996; 18:279-92. [PMID: 8723366 DOI: 10.3109/08860229609052798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The outcome of kidney transplantation was evaluated in 246 nondiabetic, CsA-treated recipients of primary cadaver transplant, divided into 4 groups according to length of time on dialysis: group < or = 2, 0-24 months; group 2-5, 25-60 months; group 5-15, 61-180 months; group > 15, over 180 months. The 4 groups did not differ in graft survival, proteinuria (g/die), or estimated GFR values at 1, 2, 3, 4, and 5 years after grafting. They did not differ in the frequency of cataract, hip osteonecrosis, tumors, or posttransplant diabetes mellitus at 3 years after grafting. Ocular hypertone (p < 0.02), tendon ruptures (p < 0.001), arterial occlusive disease of lower limbs (p < 0.01), cholelithiasis (p < 0.05), and chronic hepatitis--which occurred only in anti-HCV and/or HBs Ag-positive patients--(p < 0.001), were more frequent in group > 15, and in all these cases but ocular hypertone a linear trend of increasing frequencies with increasing dialytic age was statistically significant. Group 5-15 had the lowest patient survival (p < 0.02). Moreover, a progressive decline of patient survival with increasing dialytic age was noted in groups < or = 2, 2-5, and 5-15. Unexpectedly, group > 15 had remarkably good survival, and this finding denies the hypothesis of a purely linear decline of patient survival after transplantation with increasing dialytic age.
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Affiliation(s)
- A Vianello
- Transplant Center, Ospedale Regionale, Treviso, Italy
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Cantarovich D, Baatard R, Baranger T, Tirouvanziam A, Le Sant JN, Hourmant M, Dantal J, Soulillou JP. Cadaveric renal transplantation after 60 years of age. A single center experience. Transpl Int 1994; 7:33-8. [PMID: 8117400 DOI: 10.1007/bf00335661] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report the outcome of 121 cadaveric renal transplants performed in our institution between September 1985 and April 1992 in 117 patients, aged 60-71 years (mean 63 years) at the time of transplantation. Compared to 640 patients 20-59 years of age transplanted during the same study period, a nonstatistically significant difference was observed in the 5-year actuarial patient (80% and 90%, respectively, in recipients over and under 60 years of age) and transplant (80% and 72%, respectively, in recipients over and under 60 years of age) survival rates. However, elderly patients had significantly lower survival than recipients 20-29 years of age (P < 0.009). Fourteen patients died (all but one with a functioning graft) due to cardiovascular diseases (5%; 42.8% of total deaths), infections (3%; 28.6% of total deaths), and gastrointestinal complications (3%; 28.6% of total deaths). Younger patients showed a similar and nonsignificantly different incidence of cardiovascular- (35%) and infectious-(30%) related deaths. The incidence of acute rejection episodes and cytomegalovirus (CMV) infectious episodes was 27% and 24%, respectively, during the 1st post-transplant year. Ongoing acute rejection and CMV infectious episodes were significantly higher in patients who died than in those still alive (P < 0.002 and P < 0.02, respectively). Cyclosporin maintenance therapy was well tolerated in all patients but one, and 64% of the patients could be maintained without steroids. These data indicate that cadaveric renal transplantation is a safe and effective procedure in the management of chronic renal failure of selected patients 60 years of age or older.
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Affiliation(s)
- D Cantarovich
- Service de Néphrologie et Immunologie Clinique, Centre Hospitalier, Nantes, France
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