Implementing a pharmacist-led transition of care model for posttransplant hyperglycemia

Abstract Purpose The implementation of a pharmacist-managed transition of care program for kidney transplant recipients with posttransplant hyperglycemia (PTHG) is described. Methods In September 2015, a collaborative practice agreement between pharmacists and transplant providers at an academic medical center for management of PTHG was developed. The goal of the pharmacist-run service was to reduce hospitalizations by providing care to patients in the acute phase of hyperglycemia while they transitioned back to their primary care provider or endocrinologist. For continuous quality improvement, preimplementation data were collected from August 2014 to August 2015 and compared to postimplementation data collected from August 2017 to August 2018. The primary endpoint was hospitalizations due to hyperglycemia within 90 days post transplantation. Secondary endpoints included emergency department (ED) visits due to hypoglycemia and the number of interventions performed, number of encounters completed, and number of ED visits or admissions for hypoglycemia. A Fisher’s exact test was used to compare categorical data, and a Student t test was used to compare continuous data. A P value of <0.05 was considered to be statistically significant. Results Forty-three patients in the preimplementation group were compared to 35 patients in the postimplementation group. There was a significant reduction in hospitalizations due to hyperglycemia in the postimplementation versus the preimplementation group (9 vs 1, P < 0.05); there was a reduction in ED visits due to hyperglycemia (5 vs 0, P = 0.06). There were no ED visits or hospitalizations due to hypoglycemia in either group. Clinical transplant pharmacists performed an average of 8.3 (SD, 4.4) encounters per patient per 90 days. Conclusion A collaborative practice agreement was created and successfully implemented. A pharmacist-managed PTHG program could be incorporated into the standard care of kidney transplant recipients to help minimize rehospitalizations due to hyperglycemia.

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Factors that Influence the Durability of Transplanted Kidneys in South Africa

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4251 ◽

2019 ◽

Vol 21 (2) ◽

Author(s):

Hillary Ndemera ◽

Busisiwe R. Bhengu

Keyword(s):

South Africa ◽

Kidney Transplant ◽

Lifestyle Modification ◽

P Value ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Kidney Allograft ◽

Factors Influencing ◽

Allograft Loss ◽

Transplanted Kidneys

Kidney transplantation is the cornerstone for renal treatment in patients with end-stage renal failure. Despite improvements in short-term outcomes of renal transplantation, kidney allograft loss remains a huge challenge. The aim of the study was to assess factors influencing the durability of transplanted kidneys among transplant recipients in South Africa. A descriptive cross-sectional study design was used. A random sampling was used to select 171 participants. Data were collected through structured face-to-face interviews developed from in-depth consideration of relevant literature. Data were coded and entered into the SPSS software, version 24. The entered data were analysed using descriptive and inferential statistics. The results revealed that the average durability of transplanted kidneys was 9.07 years among selected kidney transplant recipients in South Africa. Factors associated with the durability of transplanted kidneys included age, the sewerage system and strict immunosuppressive adherence, all with a P-value = .000, followed by the mode of transport (P-value = .001) and support system (P-value = .004). Other variables including demographics, the healthcare system, medication and lifestyle modification engagement were not associated with the durability of transplanted kidneys. Understanding the factors influencing the durability of transplanted kidneys among kidney transplant recipients in South Africa is crucial. The study revealed associated factors and gaps which may be contributory factors to kidney allograft loss. This study provides an opportunity to introduce specific interventions to nephrology professionals to promote prolonged graft durability. It is recommended that a specific intervention model be developed, which targets South African kidney recipients taking into account the significant variables in this study and the socio-economic status of the country.

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P1708EFFECT OF PREGNANCY ON KIDNEY TRANSPLANT RECIPIENTS: A PROPENSITY SCORE-MATCHED STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1708 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Toyofumi Abe ◽

Taniguchi Ayumu ◽

Kawamura Masataka ◽

Kato Taigo ◽

Tomoko Namba-Hamano ◽

...

Keyword(s):

Multivariate Analysis ◽

Risk Factor ◽

Kidney Transplant ◽

Graft Survival ◽

Significant Risk ◽

Significant Risk Factor ◽

P Value ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Pregnancy And Delivery

Abstract Background and Aims This study aimed to evaluate whether the experience of pregnancy and delivery would be associated with poor maternal outcome among kidney transplant recipients. Method A total of 401 female transplant recipients from the Osaka University Transplantation Group Database were included in this study. 73 women who underwent renal transplantation between 1970 and 2017 and became pregnant and delivered at Osaka University Kidney Transplant Group Hospitals. Multivariable logistic regression analysis was used to assess the impact of pregnancy and delivery on renal transplant recipient outcome after one-to-one propensity score (PS) matching for 12 variables including serum creatinine at one year post-transplant between the parous group and the nulliparous group. The outcomes were kidney graft survival and patient survival. Results In all patients before PS matching, 75 (18.7%) of the 401 patients died and 137 (34.2%) of the 401 patients lost their kidney grafts during the follow-up period. In the multivariate analysis, pregnancy and delivery was not a significant risk factor for death (adjusted HR 0.662 [95%CI, 0.265-1.656], p-value 0.378) and for death-censored graft survival (adjusted HR 1.224 [95%CI, 0.683-2.196], p-value 0.497). In the PS matched population, 14 (17.5%) of the 80 patients died and 31 (38.8%) of the 80 patients lost their grafts. In the multivariate analysis, pregnancy and delivery was not a significant risk factor for death (adjusted HR 0.611 [95%CI, 0.180-2.072], p-value 0.430) and for death-censored graft survival (adjusted HR 1.308 [95%CI, 0.501-3.416], p-value 0.584). Conclusion Pregnancy and delivery after kidney transplantation was not associated with poor kidney transplant outcome in recipients with adequate and stable graft function.

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Development of an innovative adult attention-deficit hyperactivity disorder clinic

Mental Health Clinician ◽

10.9740/mhc.2020.09.296 ◽

2020 ◽

Vol 10 (5) ◽

pp. 296-300

Author(s):

Kelly C. Lee ◽

Estelle Kim ◽

Jaye Kim ◽

Benjamin Malcolm ◽

Grace M. Kuo ◽

...

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Adult Adhd ◽

Medical Center ◽

Academic Medical Center ◽

Collaborative Practice ◽

Psychiatric Evaluation ◽

Successful Implementation ◽

Hyperactivity Disorder ◽

Collaborative Practice Agreement

Abstract Pharmacist-psychiatrist collaborative clinic models in specialty mental health clinics are limited, and there has been only 1 report of a clinic focused on adult attention-deficit hyperactivity disorder (ADHD). In this article, we describe the successful implementation of a pharmacist-psychiatrist collaborative practice agreement in an adult ADHD clinic at an academic medical center. Adult patients diagnosed with ADHD after a comprehensive assessment, including a full neuropsychological evaluation, were enrolled in the collaborative treatment clinic. The collaboration was a partnership between a psychiatry department and a school of pharmacy at a public university. We report the details of 58 patients and 774 patient encounters at the collaborative pharmacist-psychiatrist practice from March 2015 through June 2018. The visits were billed using traditional medical billing codes for follow-up visits. Pharmacist practice opportunities included psychiatric evaluation, medication management, counseling, and referral to auxiliary services. Challenges to the clinic's success included limited pharmacist time, prescriptive authority, and reimbursement for services from payors. A collaborative practice model targeted at adult ADHD patients may be a unique clinic setting for psychiatric pharmacists.

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Induction Immunosuppression in Pediatric Kidney Transplant Recipients Under the Age of 11 with Rabbit Anti-Thymocyte Globulin

Proceedings of IMPRS ◽

10.18060/24609 ◽

2020 ◽

Vol 3 ◽

Author(s):

William Goggins ◽

Richard Mangus ◽

Burcin Ekser ◽

William Goggins

Keyword(s):

Kidney Transplant ◽

Graft Survival ◽

Lymphoproliferative Disorder ◽

Graft Loss ◽

Bk Virus ◽

P Value ◽

Induction Agent ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Post Transplant

Background: At the time of kidney transplantation (KT), induction immunosuppression is used to reduce the incidence of early rejection and avoid the use of chronic corticosteroids in maintenance immunosuppression. There is currently no standard of care for induction immunosuppression in the pediatric recipient, instead it is based on institutional preference. In this study, we compare our current induction immunosuppression, rabbit anti-thymocyte globulin (rATG), to our previous induction immunosuppression, Daclizumab in patients under the age of 11. Methods: From 07/2004 to 08/2019, 79 patients under the age of 11 have received a KT. 7 patients were excluded from analysis due to Basiliximab induction (n=3), graft loss within 10 days (n=3) and patient death (n=1). 72 patients were analyzed, of which 39 patients (54%) with rATG induction were compared to 33 patients (46%) with daclizumab induction. All patients were maintained on steroid-free immunosuppression regimen after transplant. More than 20 variables were followed, along with rejection, graft failure, and any prevalence of post-transplant lymphoproliferative disorder (PTLD) was recorded (Figure 1). Results: Patients demographics were similar in both groups. Graft survival was good and statistically similar up to 5 years. In both groups, serum creatinine levels were similar up to 1 year follow up. Although CMV infection was similar in both groups, BK viremia and BK virus in the urine were more frequent in rATG group. Post-transplant lymphoproliferative disorder was significantly higher in the Daclizumab group (p=0.022), but less acute rejection was observed in the Daclizumab group (Figure 1). Potential Impact: Our study suggests that rATG is a safe and effective induction agent in pediatric kidney transplant recipients under the age of 11. Recipients have excellent patient and graft survival. It is associated with strong kidney function and low PTLD. Screening for BK virus in the urine is essential with rATG induction. Table 1: Induction Agent Daclizumab rATG p value Demographics Number 33 39 N.S. Sex 15M, 18F 27M, 12F 0.042 Age (years) 5.5 ± 2.7 6.1 ± 2.7 N.S. Height (m) 1.02 ± 0.23 1.06 ± .21 N.S. Weight (kg) 18.75 ± 9.93 19.08 ± 6.42 N.S. Outcomes Cr 1 month (mg/dL) 0.56 ± .31 0.45 ± .17 0.056 Cr 6 months (mg/dL) 0.54 ± .22 0.52 ± .18 N.S. Cr 1 year (mg/dL) 0.63 ± .27 0.59 ± .17 N.S. eGFR 1 month (ml/min/1.73m2) 84.81 ± 27.95 107.08 ± 30.09 0.0019 eGFR 6 months (ml/min/1.73m2) 85.04 ± 27.60 92.48 ± 28.07 N.S. eGFR 1 year (ml/min/1.73m2) 74.31 ± 26.8 79.3 ± 22.01 N.S. Rejection 6 months 1 (3.03%) 8 (20.51%) 0.0188 Rejection 1 year 2 (6.06%) 8 (20.51%) 0.0682 Graft Survival 1 year 100% (33/33) 100% (39/39) N.S. Graft Survival 3 years 96.97% (32/33) 100% (25/25) N.S. Graft Survival 5 years 96.88 (31/32) 100% (22/22) N.S. Cases of PTLD 5 (18.18%) 0 (0%) 0.022 Chronic steroid use 2 (6.06%) 2 (5.13%) N.S. BK Urine only 1 year 0% (0/33)* 10.26% (4/39) 0.0439 BK Viremia 1 year 3.03% (1/33)* 17.95% (7/39) 0.0356 CMV Viremia 1 year 0% (0/33) 5.13% (2/39) N.S. N.S.= Not statistically significant. *BK screening was not routine during time of daclizumab induction

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P1014INCRETIN BASED THERAPIES IN DIABETIC KIDNEY TRANSPLANT RECIPIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1014 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Theodora Oikonomaki ◽

Evangelia Ntounousi ◽

ANILA DUNI ◽

Stefanos Roumeliotis ◽

Dimitrios Divanis ◽

...

Keyword(s):

Kidney Transplant ◽

Publication Bias ◽

Meta Analysis ◽

P Value ◽

Solid Organ ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Before And After ◽

Secondary Outcomes

Abstract Background and Aims Diabetes mellitus (DM) is the major cause of ESRD. New-onset DM after transplantation (NODAT) frequently occurs and increases the risk of infection and mortality. Kidney transplant recipients (KTR) with pre-existing risk factors for DMt2 are more prone to develop NODAT. An intriguing novel concept is the use of the incretin-based therapies including dipeptidyl peptidase-4 inhibitors (DPP-4i), glucagon-like peptide-1 receptor agonists (GLP-1-RAs) and Sodium-glucose co-transporter-2 inhibitors (SGLT2i) in solid organ transplantation. This class of antidiabetic therapy is not yet established in KTR. Our aim was to examine the efficacy and safety of incretin-based therapies in DM or NODAT in KTR. Method We searched without language restrictions for all publications on Kidney/Renal Transplantation and DPP-4i, GLP-1-RAs and SGLT-2i using electronic databases including Medline, Embase, Cochrane, PubMed. We hand-search the reference lists of every relevant study for additional publications. Further searches were done by reviewing abstract and review articles. We included every study (retrospective/prospective) that used these classes of antidiabetics as treatment of NODAT or DMt2 in KTR. All the primary and secondary outcomes were calculated as mean ± sd. Heterogeneity was assessed with Cochrane’s Q statistics and quantified using the I stat, which indicated the proportion of variability across studies that was due to heterogeneity. We used the DerSimonian-Laird estimator for tau^2. Meta-regression was used to assess the effect of different antidiabetics on the primary and secondary outcomes. We assumed a priori the presence of heterogeneity and we used the model of random effects in all analyses. We assessed publication bias using the Begg-Mazumdar test and to nullify the estimated bias the trim-and-fill method, where it was necessary. A p-value < 0.05 was considered statistical significant. Results On the 1512 references screened, 16 studies were included in the final analysis. In total, 310 individuals were analyzed with a mean age of 55.98 ± 8.81 years, similar between studies. In 10 of them, participants were diagnosed with NODAT, whereas in all other trials were DMt2 or NODAT. In 8 studies participants received DPP-4i, in 6 SGLT-2i i and in rest 2 GLP-1-RAs. All included KTR were stable and transplanted over 6 months. The mean follow-up of all trials included was 22,03±14.95 weeks. Glycemic control reduces HbA1c (10 studies, MD=-0.38 %, I=45%). The MD of HbA1c for the DPP-4i group was -0.3741 and for the SGLT-2i group was -0.4596 mg/dl. Within every group of each different category of drugs, there was homogeneity (QM, p-value>0.05) and it was explained the most of the variance of the previous meta-analysis (QE= 15.76). The Begg-Mazumdar test showed that publication bias was not present (p> 0.05). Nine trials reported the difference of FPG and 5 of PPG before and after the administration of antidiabetics. The common MD estimator with a random effect model was – 25.76 for FPG and – 6.61 for PPG with a high grade of heterogeneity for both. Seven trials reported the change of body mass index (BMI) and body weight (BW) before and after the administration of this class of antidiabetics. The BW reduction, where reported, was significant in KTR on SGLT1i or DPP-4i whereas BMI wasn’t significantly reduced in this group, possible due to statistical artifact. The majority of the studies showed that GFR and hepatic biochemical parameters, didn’t change during therapy (DPP-4i, GLP-1-RAs, SGLT-2i). Conclusion Evidence concerning the efficacy of incretins in diabetes on KTR is limited. SGLT2i and DPP-4i are efficacious for glucose-lowering. The safety profile based on renal and hepatic function is indicative for the use of this class of antidiabetics in this population. More high-quality studies are required to help guide therapeutic choice for antidiabetics in KTR.

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Number of Regularly Prescribed Drugs and Intrapatient Tacrolimus Trough Levels Variability in Stable Kidney Transplant Recipients

Journal of Clinical Medicine ◽

10.3390/jcm9061926 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1926

Author(s):

Piotr Giza ◽

Rafał Ficek ◽

Tomasz Dwulit ◽

Jerzy Chudek ◽

Iwona Woźniak ◽

...

Keyword(s):

Kidney Transplant ◽

Multivariate Regression Analysis ◽

P Value ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Term Outcome ◽

Long Term Outcome ◽

Group A ◽

Group 2 ◽

Concomitant Medications

High intra-patient variability (IPV) of tacrolimus levels is associated with poor long-term outcome after transplantation. We aimed to evaluate whether the number of regularly prescribed medications is associated with the tacrolimus IPV. We have studied 152 kidney transplant recipients (KTRs) with mean post-transplant time of 6.0 ± 3.1 years. The coefficient of variation (CV) as a measure of IPV was calculated in each individual patient. Data concerning the type and number of currently prescribed medications were collected. The participants were divided into four groups, based on the number of regularly prescribed drugs (≤3, 4–6, 7–9, ≥10 drugs, respectively). There was an increasing trend for median CV, proportional to the increasing number of medications [group 1: 0.11 (interquartile range, 0.08–0.14), group 2: 0.14 (0.01–0.17), group 3: 0.17 (0.14–0.23), group 4: 0.17 (0.15–0.30); p value for trend = 0.001]. Stepwise backward multivariate regression analysis revealed that the number of medications [partial correlation coefficient (rpartial) = 0.503, p < 0.001] independently influenced the tacrolimus IPV. Concomitant steroid or diuretics use increased IPV only in Advagraf-treated KTRs, whereas proton-pump inhibitor or statin use increased IPV in the Prograf group but not in the Advagraf group. A large number of concomitant medications significantly increases the tacrolimus IPV in stable KTRs.

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Unmet Care Needs and Related Factors of Spouses of Liver or Kidney Transplant Recipients

Clinical Nursing Research ◽

10.1177/1054773820985289 ◽

2021 ◽

pp. 105477382098528

Author(s):

Yu-Hsuan Chang ◽

Yeur-Hur Lai ◽

Po-Huang Lee ◽

Meng-Kun Tsai ◽

Shiow-Ching Shun

Keyword(s):

Kidney Transplant ◽

Health Care Professionals ◽

Unmet Needs ◽

Medical Center ◽

Kidney Transplant Recipient ◽

Psychological Needs ◽

Specific Information ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Care Needs

This study aimed to (1) explore the unmet care needs of spouses of liver or kidney transplant recipients, (2) compare the unmet care needs, depression, and anxiety levels of transplant recipients and their spouses, and (3) identify factors related to spouses’ unmet care needs. A cross-sectional study was conducted using purposive sampling from transplant outpatient departments at a medical center. Ninety-one liver or kidney transplant recipient–spouse dyads were recruited. Most unmet needs for dyads were involved in the psychological needs and health system and service needs domains. Spouses had significantly higher unmet needs, anxiety, and depression than recipients did. The significant factors related to the spouses’ unmet needs included being male, having higher anxiety, and whose partners had higher unmet needs. Health care professionals must attend to the needs of both recipients and spouses. Providing disease-specific information and resources to spouses who potentially had higher unmet needs is strongly suggested.

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Proteinuria in Kidney Transplant Recipients

Bangladesh Journal of Urology ◽

10.3329/bju.v17i2.49151 ◽

2020 ◽

Vol 17 (2) ◽

pp. 61-63

Author(s):

Md Habibur Rahman ◽

Tohid Mohammad Saiful Hossain ◽

AKM Khurshidul Alam ◽

Shahidul Islam Selim ◽

Nilima Barman ◽

...

Keyword(s):

Renal Transplant ◽

Kidney Transplant ◽

Cross Sectional Study ◽

P Value ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Cross Sectional ◽

Female Ratio ◽

Transplant Patients

Objectives: Proteinurea is one of the major causes of early graft rejection and high degree mortality in renal transplant patients. Our objective was to assess risk in post transplant patient for proteinurea and it’s appropriate management. Methods: This cross sectional study includes fifty adult kidney allograft recipients, transplanted in kidney transplant unit of Urology Department, Bangabandhu Sheikh Mujib Medical University in the period of January 2012 to December 2012. Results: In our series, proteinuria was detected in 44% of the renal transplant recipients in variant amount. In this study the male and female ratio was 7:3. There was a highly significant level of proteinuria in proteinuric group than that of non-proteinuric group [538.09 (313.36) mg/24 hr vs. 44.48 (23.39) mg/24 hr; p value <0.0001]. Acute rejection and death was found in 22% and 8% recipients respectively, which were more observed in proteinuric group. Conclusion: Based on these data, proteinuria should be monitored periodically at posttransplant period and investigation of the cause should be pursued vigorously. Bangladesh Journal of Urology, Vol. 17, No. 2, July 2014 p.61-63

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Weight Change in Kidney Transplant Recipients: An Academic Medical Center-Based Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa063_035 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1637-1637

Author(s):

Cheryl Gibson ◽

Rebecca Mount ◽

Heather Valentine ◽

Debra Sullivan

Keyword(s):

Body Weight ◽

Weight Gain ◽

Kidney Transplant ◽

Weight Change ◽

Academic Medical Center ◽

Graft Function ◽

Data Repository ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Post Transplant

Abstract Objectives Kidney transplant recipients often experience weight gain in the first year after transplantation and this weight gain is associated with higher rates of cardiovascular disease, new-onset diabetes, metabolic syndrome and loss of graft function. The purpose of this study was to examine the characteristics of transplant recipients at our institution and describe post-transplant weight change. Methods Utilizing the institution's research data repository, we searched for adult kidney transplant patients from January 2014 through February 2019. Percent weight change at 6 and 12 months was calculated as a percentage of total body weight from time of transplant. Weight gain was defined as an increase of 5% or more while weight stable was classified as no weight change or less than 5% gain. Weight loss was defined as losing 5% or more of body weight from baseline. Results Of 598 cases, the sample was predominantly male (n = 361; 60%), married (n = 355; 59%) and white (n = 415; 69%). At transplant, mean age was 51.3 ± 13.5 years and mean weight was 85.26 ± 20.10 kg (males = 90.62 ± 20.73 kg; females = 77.53 ± 16.33 kg). At 6 months post-transplant, 87% of recipients (n = 518) had recorded weights. Of those individuals, 26% (n = 133) experienced weight gain (mean + 11.9%; median + 9.9%), gaining on average 8.9 ± 5.09 kg. Thirty one % (n = 163) lost weight (mean −10.3%; median - 8.8%), and 43% (n = 222) were weight stable. At 12 months post-transplant, 78.1% (n = 467) of patients had recorded weights. Of those individuals, 42% (n = 195) experienced weight gain (mean + 13%, median + 10%), 18% (n = 86) lost weight (mean −10.95%, median - 8.94%), and 40% (n = 185) maintained baseline weight. Those who gained weight during this period experienced a 10.16 ± 6.00 kg increase. Conclusions Post-transplant weight gain is a critical issue among our institution's kidney transplant recipients with more than 40% gaining significant weight, placing them at risk for early mortality and decreased graft survival. Healthcare professionals should continue to educate and direct recipients to weight management programs to control the amount of weight gained following transplantation. Helping kidney transplant recipients prevent unnecessary weight gain is essential to their prolonged survival and quality of life. Funding Sources None.

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MO958IMPACT OF COMBINED AGE OF LIVING DONOR AND RECIPIENT OF KIDNEY TRANSPLANTATION ON PATIENT AND GRAFT OUTCOME

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.0037 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Ibrahim Galalah ◽

Amir El-Okely ◽

Ibrahim Salem ◽

Mohammed Bakr

Keyword(s):

Kidney Transplant ◽

Patient Survival ◽

Group Iv ◽

P Value ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Group Iii ◽

Post Transplant ◽

Graft Outcome ◽

Group I

Abstract Background and Aims Although outcomes of solid organ transplantation are excellent in the modern era, the scarcity of donor organs relative to patients on the waiting list has remained a limitation of the field. One of the most doubtful points in donor evaluation is donor age and its impact on graft outcome. The kidney, like most organs, undergoes a progressive decline in function with advancing age. Aim: our aim is to evaluate the combined age of recipient and donor on graft and patient survival. Method This retrospective cohort study was held in Mansoura Urology and Nephrology Center, Mansoura University, Egypt. The study included all kidney transplant recipients received allo-renal transplantation in the center during the period between March 1976 and December 2019 (3068 KTRs). The patients were divided into 4 main groups according to recipient and donor age: Group I: Kidney transplant recipients < 40 years from donors < 40 years (1665 KTrs), Group II: Kidney transplant recipients < 40 years from donors ≥ 40 years (932 KTrs), Group III: Kidney transplant recipients ≥ 40 years from donors < 40 years (320 KTrs) and Group IV: Kidney transplant recipients ≥40 years from donors ≥ 40 years (151 KTrs). Results 73.6% of the included recipients were males while 55% of donors were females. Transplantation from related donors is the rule in all groups. Incidence of hypertension was more frequent with old recipients in group III and IV. About 95% of the patients received hemodialysis before transplantation for about 1.6±0.3 years. As regard immunosuppression, steroid-based and cyclosporine-based regimen was used more in group III (p value: 0.0001, 0.0001 respectively). While, tacrolimus-based regimen was used frequently in group IV. Azathioprine use was higher among group III while MMF use was higher in group IV. Incidence of acute rejection and chronic rejection was higher in group I and of lower incidence in group VI. Incidence of post-transplant hypertension, diabetes and hepatic impairment occurred more frequently in group III and lower frequency in group I. Incidence of malignancy was higher in group III (p value: 0.0001). Serum creatinine at the end of the year for 5 years after transplantation was higher in group IV and lower in group I with statistical significant difference. Overall, 5, 10 and 15 years graft survival was better in group I and worse in group III (p value: 0.012) (figure 1). 5, 10 and 15 years patient survival was higher in group II and lower in group IV (p value: 0.013) (figure 2). Conclusion Combined donor-recipient age affects both graft function and transplantation complications. Young donor to young recipient transplantation was associated with higher incidence of rejection but lower incidence of post-transplant medical complications. Young donor to old recipient transplantation was associated with higher incidence of post-transplant medical complications and malignancy. Old donor to old recipient transplantation was associated with the lowest incidence of rejection.

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