Kidney transplantation in the extremely elderly from extremely aged deceased donors: a kidney for each age

2020 ◽  
Vol 35 (4) ◽  
pp. 687-696
Author(s):  
Jimena Cabrera ◽  
Mario Fernández-Ruiz ◽  
Hernando Trujillo ◽  
Esther González ◽  
María Molina ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Cox Regression ◽  
Patient Survival ◽  
Incidence Rates ◽  
Allocation Policy ◽  
Recipient Age ◽  
Deceased Donors ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Advances in life expectancy have led to an increase in the number of elderly people with end-stage renal disease (ESRD). Scarce information is available on the outcomes of kidney transplantation (KT) in extremely elderly patients based on an allocation policy prioritizing donor–recipient age matching. Methods We included recipients ≥75 years that underwent KT from similarly aged deceased donors at our institution between 2002 and 2015. Determinants of death-censored graft and patient survival were assessed by Cox regression. Results We included 138 recipients with a median follow-up of 38.8 months. Median (interquartile range) age of recipients and donors was 77.5 (76.3–79.7) and 77.0 years (74.7–79.0), with 22.5% of donors ≥80 years. Primary graft non-function occurred in 8.0% (11/138) of patients. Cumulative incidence rates for post-transplant infection and biopsy-proven acute rejection (BPAR) were 70.3% (97/138) and 15.2% (21/138), respectively. One- and 5-year patient survival were 82.1 and 60.1%, respectively, whereas the corresponding rates for death-censored graft survival were 95.6 and 93.1%. Infection was the leading cause of death (46.0% of fatal cases). The occurrence of BPAR was associated with lower 1-year patient survival [hazard ratio (HR) = 4.21, 95% confidence interval (CI) 1.64–10.82; P = 0.003]. Diabetic nephropathy was the only factor predicting 5-year death-censored graft survival (HR = 4.82, 95% CI 1.08–21.56; P = 0.040). Conclusions ESRD patients ≥75 years can access KT and remain dialysis free for their remaining lifespan by using grafts from extremely aged deceased donors, yielding encouraging results in terms of recipient and graft survival.

scholarly journals Monoclonal gammopathy of undetermined significance coexisting in patients undergoing kidney transplantation does not adversely influence post-graft clinical outcome

2020 ◽  
Author(s):  
Roberta Clari ◽  
Corrado Tarella ◽  
Roberta Giraudi ◽  
Maria Cristina Torazza ◽  
Ester Gallo ◽  
...  
Keyword(s):  
Graft Survival ◽  
Monoclonal Gammopathy ◽  
Patient Survival ◽  
Diagnostic Procedures ◽  
Control Group ◽  
Patient Death ◽  
Post Transplant ◽  
Stage Renal Disease ◽  
End Stage ◽  
Undetermined Significance

Abstract Background Management of patients with oncohaematological disorders such as monoclonal gammopathy of undetermined significance (MGUS) is a frequent problem in pre-transplant work-up. Insights on disease progression and long-term functional outcomes are still lacking in this setting. Methods This was a retrospective analysis on all patients with MGUS who underwent kidney transplant (KT) at our centre between 1 January 2000 and 31 December 2017 (cases, n = 65). Patients were matched with a control group (KTs with similar characteristics but without history of haematological disease, controls, n = 1079). Primary endpoints were graft and patient survival; secondary endpoints were causes of graft failure, patient death, occurrence of allograft rejection, post-transplant neoplasia (not correlated to previous disorder) and/or infectious episodes. Results The MGUS and control groups had a similar mean age [60 (29–79) versus 55.2 (19.3–79.5) years, respectively] and percentage of males (69.2% versus 64.6%, respectively). Median follow-up time since KT was 3.5 years (0–14) in cases and 8.3 years (0–14.9) in controls. All MGUS patients underwent KT following extensive multidiscliplinary investigations. No differences were found between cases and controls regarding patient and graft survival or post-transplant complications except for lower incidence of infections (58.7% versus 69.8%, P = 0.019) and increased use of mTOR inhbitors (30.3% versus 14.7%, P = 0.001) in MGUS. MGUS isotype did not influence graft and patient survival. The absence of difference in patients and graft survival was also confirmed in an adjunctive analysis where MGUS were compared with controls (ratio 1:2) matched for recipient age, gender, number of transplantations and transplant period. Conclusion Patients with MGUS may undergo KT without significantly increased risks of complications, provided that appropriate diagnostic procedures are carefully followed. Multidiscipline-based studies are crucial for establishing well designed pre- and post-transplant protocols for the best management of patients with coexisting MGUS and end-stage renal disease.

scholarly journals P1706THE GRAFT SURVIVAL OF KIDNEY TRANSPLANTATION ACCORDING TO ETHNICITY IN KIDNEY TRANSPLANT RECIPIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yeonsoon Jung ◽  
Jisu Kim ◽  
Haesu Jeon ◽  
Ye Na Kim ◽  
Ho Sik Shin ◽  
...  
Keyword(s):  
African American ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Cox Regression ◽  
Patient Survival ◽  
Graft Loss ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Data Set

Abstract Background African American kidney transplant recipients experience disproportionately high rates of graft loss. The aim of this analysis was to use a UNOS data set that contains detailed baseline and longitudinal clinical data to establish and quantify the impact of the current overall graft loss definition on suppressing the true disparity magnitude in US AA kidney transplant outcomes. Methods Longitudinal cohort study of kidney transplant recipients using a data set created by United Network for Organ Sharing (UNOS), including 266,128 (African American 70,215, Non-African American 195,913) transplant patient between 1987 and December 2016. Multivariable analysis was conducted using 2-stage joint modeling of random and fixed effects of longitudinal data (linear mixed model) with time to event outcomes (Cox regression). Results 195,913 non-African American (AA) (73.6%) were compared with 70,215 AA (26.4%) recipients. 10-year-graft survival of AA in all era is lower than that of non-AA (31% in deceased kidney transplants (DKT) AA recipient and 42% in living kidney transplantation (LKT) non-AA recipient). 10-year-patient survival of AA with functioning graft in all era is similar that of non-AA. Multivariate Cox regression of factors associated with patient survival with functioning graft are acute rejection within 6 months, DM, hypertension and etc. Pre-transplant recipient BMI in AA show the trend as a protective factor in patient survival with functioning graft although not significantly in statistics Conclusions African American kidney transplant recipients experience a substantial disparity in graft loss, but not patient death with functioning graft.

scholarly journals Improved patient survival with simultaneous pancreas and kidney transplantation in recipients with diabetic end-stage renal disease

Diabetologia ◽  
2013 ◽  
Vol 56 (6) ◽  
pp. 1364-1371 ◽  
Author(s):  
J. P. Lindahl ◽  
A. Hartmann ◽  
R. Horneland ◽  
H. Holdaas ◽  
A. V. Reisæter ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Patient Survival ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Targeting Mitochondria during Cold Storage to Maintain Proteasome Function and Improve Renal Outcome after Transplantation

2020 ◽  
Vol 21 (10) ◽  
pp. 3506
Author(s):  
Sorena B. Lo ◽  
Richard T. Blaszak ◽  
Nirmala Parajuli
Keyword(s):  
Kidney Transplantation ◽  
Cold Storage ◽  
Renal Damage ◽  
Patient Survival ◽  
Renal Outcome ◽  
Protein Homeostasis ◽  
Deceased Donors ◽  
End Stage ◽  
Storage Times

Kidney transplantation is the preferred treatment for end-stage kidney disease (ESKD). Compared to maintenance dialysis, kidney transplantation results in improved patient survival and quality of life. Kidneys from living donors perform best; however, many patients with ESKD depend on kidneys from deceased donors. After procurement, donor kidneys are placed in a cold-storage solution until a suitable recipient is located. Sadly, prolonged cold storage times are associated with inferior transplant outcomes; therefore, in most situations when considering donor kidneys, long cold-storage times are avoided. The identification of novel mechanisms of cold-storage-related renal damage will lead to the development of new therapeutic strategies for preserving donor kidneys; to date, these mechanisms remain poorly understood. In this review, we discuss the importance of mitochondrial and proteasome function, protein homeostasis, and renal recovery during stress from cold storage plus transplantation. Additionally, we discuss novel targets for therapeutic intervention to improve renal outcomes.

scholarly journals EVALUATIONOFRENAL REPLACEMENT THERAPYQUALITY IN UKRAINE: TIME FOR ACTIONS

2015 ◽  
pp. 3-12
Author(s):  
Mykola Kolesnyk ◽  
Nadiya Kozlyuk
Keyword(s):  
Cox Regression ◽  
Patient Survival ◽  
International Perspective ◽  
Soviet Period ◽  
Kaplan Meier ◽  
Home Based ◽  
The Status ◽  
Stage Renal Disease ◽  
End Stage

Background. Little is known about the status of renal replacement therapy (RRT) in the post-Soviet period of Ukraine. We therefore investigated the epidemiology and treatment outcomes of RRT in Ukrainian patients and put the results into an international perspective. Methods. Data from the Ukrainian National Renal Registry for patients on RRT between 1 January 2010 and 31 December 2012 were selected. We calculated the incidence and prevalence of RRT per million population (pmp) and the 3-, 12- and 24-month patient survival using the Kaplan— Meier method and Cox regression Results. There were 5985prevalent patients on RRT on 31 December 2012 (131,2 pmp). Mean age was 46,5 ± 13,8 years, 56% were men and 74% received haemodialysis (HD), while peritoneal dialysis and kidney transplantation both represented 13%. The most common cause of end-stage renal disease was glomerulonephritis (51%), while only 12% had diabetes. In 2012, 1129 patients started dialysis (incidence 24,8 pmp), with 80% on HD. Mean age was 48 ± 14 years, 58% were men and 20% had diabetes. Three, 12- and 24-month patient survival on dialysis was 95,1%, 86,0% and 76,4%, respectively. The transplant rate in 2012 was 2,1 pmp. Conclusions. The incidence and prevalence of RRT and the transplantation rate in Ukraine are among the lowest in Europe, suggesting that the need for RRT is not being met. Strategies to reduce the RRT deficit include the development and improvement of transplantation and home-based dialysis programs. Further evaluation of the quality of Ukrainian RRT care is needed.

scholarly journals REPEAT KIDNEY TRANSPLANTATION

2017 ◽  
Vol 18 (4) ◽  
pp. 157-169 ◽  
Author(s):  
A. I. Sushkov
Keyword(s):  
Kidney Transplantation ◽  
Patient Survival ◽  
Complication Rates ◽  
Transplant Recipients ◽  
Short Term ◽  
Term Survival ◽  
Stage Renal Disease ◽  
End Stage ◽  
Length Of Life

Nowadays, kidney transplantation is the best approach of renal replacement therapy for the majority of patients with end-stage renal disease that significantly improves the quality and length of life. Advances in the field of organ donation, immunosuppression, transplant surgery and immunology have improved short-term graft and patient survival. But the long-term graft survival remains static over last two decades. The disparity between low graft and high patient long-term survival led to increasing number of transplant recipients with failed grafts. Repeat renal transplant is presumed to be a good option for many patients losing their grafts, but it is associated with higher complication rates. Unfortunately, there are no evidence-based recommendations or guidelines for renal retransplantation procedure. This review is based on 100 scientifi c publications related to various aspects of the kidney retransplantation and provides the recent data on this matter.

Dealing With Uncertainty

2021 ◽  
pp. 350-368
Author(s):  
Lainie Friedman ◽  
J. Richard Thistlethwaite, Jr
Keyword(s):  
Graft Survival ◽  
End Stage Renal Disease ◽  
Living Donors ◽  
Risk Alleles ◽  
Decision Making Processes ◽  
Deceased Donors ◽  
Stage Renal Disease ◽  
End Stage ◽  
Apolipoprotein L1

Apolipoprotein L1 (APOL1) may explain much of the excess rate of end-stage renal disease (ESRD) in Blacks compared to Whites. Kidney grafts from deceased donors with two APOL1 risk alleles have worse graft survival, but outcomes appear unaffected by recipient APOL1 status. Unknown is whether unilateral nephrectomy increases the risk of ESRD in living donors with two APOL1 risk alleles and whether their donated kidneys have worse graft survival compared with other living donor grafts. This chapter addresses the decision-making processes of the donor and candidate with their respective separate transplant teams when incomplete data about long-term safety and outcome have implications for both patients. The chapter argues that voluntary APOL1 testing should be offered to prospective Black living donors but the results should only be shared with potential recipients with the living donor’s consent. Living donors are patients who have a right to privacy about their genetic makeup.

scholarly journals Risk-Adjusted Analysis of Relevant Outcome Drivers for Patients after More Than Two Kidney Transplants

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Lampros Kousoulas ◽  
Florian W. R. Vondran ◽  
Paulina Syryca ◽  
Juergen Klempnauer ◽  
Harald Schrem ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Graft Survival ◽  
Patient Survival ◽  
Therapeutic Option ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Adjusted Analysis ◽  
Stage Renal Disease ◽  
End Stage

Renal transplantation is the treatment of choice for patients suffering end-stage renal disease, but as the long-term renal allograft survival is limited, most transplant recipients will face graft loss and will be considered for a retransplantation. The goal of this study was to evaluate the patient and graft survival of the 61 renal transplant recipients after second or subsequent renal transplantation, transplanted in our institution between 1990 and 2010, and to identify risk factors related to inferior outcomes. Actuarial patient survival was 98.3%, 94.8%, and 88.2% after one, three, and five years, respectively. Actuarial graft survival was 86.8%, 80%, and 78.1% after one, three, and five years, respectively. Risk-adjusted analysis revealed that only age at the time of last transplantation had a significant influence on patient survival, whereas graft survival was influenced by multiple immunological and surgical factors, such as the number of HLA mismatches, the type of immunosuppression, the number of surgical complications, need of reoperation, primary graft nonfunction, and acute rejection episodes. In conclusion, third and subsequent renal transplantation constitute a valid therapeutic option, but inferior outcomes should be expected among elderly patients, hyperimmunized recipients, and recipients with multiple operations at the site of last renal transplantation.

Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America

Lupus ◽  
2021 ◽  
pp. 096120332110286
Author(s):  
Joaquín Rodelo ◽  
Luis Alonso González ◽  
José Ustáriz ◽  
Silvia Matera ◽  
Keylis Pérez ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplant ◽  
Lupus Nephritis ◽  
Graft Survival ◽  
Patient Survival ◽  
Graft Loss ◽  
Single Center ◽  
Increased Risk ◽  
Recipient Age ◽  
One Year

Objective We assessed patient and graft outcomes and prognostic factors in kidney transplantation in patients with end-stage kidney disease (ESKD) secondary to lupus nephritis (LN) undergoing kidney transplantation from August 1977 to December 2014 in a Latin American single center. Methods The primary endpoint was patient survival, and the secondary endpoints were death-censored graft survival for the first renal transplant and the rate of recurrent LN (RLN). Kaplan–Meier method was used for survival analysis. Factors predicting patient and death-censored graft survivals were examined by Cox proportional-hazards regression analyses. Results 185 patients were retrospectively evaluated. Patient survival rates were 88% at one year, 82% at three years, 78% at five years, and 67% at ten years. Death-censored graft survival for the first renal transplant was 93% at one year, 89% at three years, 87% at five years, and 80% at ten years. RLN was diagnosed in 2 patients (1.08%), but no graft was lost because of RLN. Thirty-nine (21.1%) patients died, and 65 (35.1%) patients experienced graft loss during the follow-up. By multivariable analyses, older recipient age and 1-month posttransplantation eGFR <45 ml/min/1.73m2 were associated with lower patient survival and an increased risk of graft loss, while induction immunosuppressive therapy exerted a protective effect on patients’ survival. In the subgroup of patients in whom disease activity was measured at the time of transplantation, a higher SLEDAI score was also associated with lower patient survival and an increased risk of graft loss. Conclusion In a mostly Mestizo population, kidney transplantation is an excellent therapeutic alternative in LN patients with ESKD. Older recipient age, an eGFR <45 ml/min/1.73m2 at one month posttransplantation, and disease activity at the time of transplantation are predictive of a lower patient and death-censored graft survival, while induction immunosuppressive therapy has a protective effect on patient survival. RLN is rare and does not influence the risk of graft loss.

scholarly journals Providers’ View on the First Kidney Transplantation Center in Ethiopia: Experience From Past to Present

2021 ◽  
Vol 8 ◽  
pp. 233339282110183
Author(s):  
Tariku Shimels ◽  
Abrham Getachew ◽  
Mekdim Tadesse ◽  
Alison Thompson
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplant ◽  
Health Care Providers ◽  
Study Data ◽  
Care Providers ◽  
Transplant Center ◽  
Transplantation Center ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Transplantation is the optimal management for patients with end-stage renal disease. In Ethiopia, the first national kidney transplantation center was opened at St. Paul’s Hospital Millennium Medical College in September 2015. The aim of this study was to explore providers’ views and experiences of the past to present at this center. Methods: A qualitative study design was employed from 1st November to 15th December, 2019. To ensure that appropriate informants would provide rich study data, 8 health care providers and top management members were purposefully chosen for in-depth interviews. A maximum variation sampling method was considered to include a representative sample of informants. Interviews were digitally audio-recorded, and transcribed verbatim. Transcribed data was coded and analyzed using Qualitative Data Analysis (QDA) Minor Lite software and Microsoft-Excel. Result: The participants (5 males and 3 females) approached were from different departments of the renal transplant center, and the main hospital. Eight main themes and 18 sub-themes were generated initially from all interviews totaling to 109 index codes. Further evaluation and recoding retained 5 main themes, and 14 sub-themes. The main themes are; challenges experienced during and after launching the center, commitment, sympathy and satisfaction, outcomes of renal transplant, actions to improve the quality of service, and how the transplant center should operate. Providers claim that they discharge their responsibilities through proper commitment and compassion, paying no attention to incentive packages. They also explained that renal transplantation would have all the outcomes related to economic, humanistic and clinical facets. Conclusion and Recommendation: A multitude of challenges were faced during and after the establishment of the first renal transplant center in Ethiopia. Providers discharge their responsibility through a proper compassion for patients. Concerned stakeholders should actively collaborate to improve the quality of renal transplant services in the center.

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