scholarly journals Influence of Deceased Donor and Pretransplant Recipient Parameters on Early Overall Kidney Graft-Survival in Germany

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Carl-Ludwig Fischer-Fröhlich ◽  
Marcus Kutschmann ◽  
Johanna Feindt ◽  
Irene Schmidtmann ◽  
Günter Kirste ◽  
...  
Keyword(s):  
Risk Factors ◽  
Graft Survival ◽  
Cox Regression ◽  
Organ Procurement ◽  
Deceased Donor ◽  
Kidney Graft ◽  
Significance Level ◽  
Cardiovascular Comorbidity ◽  
Deutsche Stiftung Organtransplantation ◽  
The Impact

Background. Scarcity of grafts for kidney transplantation (KTX) caused an increased consideration of deceased donors with substantial risk factors. There is no agreement on which ones are detrimental for overall graft-survival. Therefore, we investigated in a nationwide multicentre study the impact of donor and recipient related risks known before KTX on graft-survival based on the original data used for allocation and graft acceptance.Methods. A nationwide deidentified multicenter study-database was created of data concerning kidneys donated and transplanted in Germany between 2006 and 2008 as provided by the national organ procurement organization (Deutsche Stiftung Organtransplantation) and BQS Institute. Multiple Cox regression (significance level 5%, hazard ratio [95% CI]) was conducted (n=4411, isolated KTX).Results. Risk factors associated with graft-survival were donor age (1.020 [1.013–1.027] per year), donor size (0.985 [0.977–0.993] per cm), donor’s creatinine at admission (1.002 [1.001–1.004] perµmol/L), donor treatment with catecholamine (0.757 [0.635–0.901]), and reduced graft-quality at procurement (1.549 [1.217–1.973]), as well as recipient age (1.012 [1.003–1.021] per year), actual panel reactive antibodies (1.007 [1.002–1.011] per percent), retransplantation (1.850 [1.484–2.306]), recipient’s cardiovascular comorbidity (1.436 [1.212–1.701]), and use of IL2-receptor antibodies for induction (0.741 [0.619–0.887]).Conclusion. Some donor characteristics persist to impact graft-survival (e.g., age) while the effect of others could be mitigated by elaborate donor-recipient match and care.

MO942PREDICTORS OF DELAYED GRAFT FUNCTION IN KIDNEY TRANSPLANT RECIPIENTS THROUGHOUT 3 DECADES: A SINGLE-CENTER EXPERIENCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Carolina Figueiredo ◽  
Mariana Fernandes ◽  
Filipe Mira ◽  
Clara Pardinhas ◽  
Rita Leal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Graft Survival ◽  
Univariate Analysis ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Kidney Graft ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Ischemia Time ◽  
The Impact

Abstract Background and Aims Delayed graft function (DGF), defined as the need for dialysis within one week post-transplantation, is associated with poorer kidney graft survival. We aimed to identify risk factors for DGF throughout 3 decades and evaluate their effect on graft survival. Method Retrospective study including 3081 kidney transplants performed at our transplantation unit between January 1st, 1989 and December 31st, 2018, split in 3 decades (1: 1989-1998; 2: 1999-2008; 3: 2009-2018). Data regarding donor and recipient demographics, time on dialysis, immunization, cold ischemia time, hemodynamic parameters and immunosuppression were collected from our prospectively maintained data base. Results Main donor, recipient and perioperative characteristics are summarized in table 1. There were clear differences in these characteristics between the decades, standing out more adverse features from both recipients and donors. Overall incidence rate of DGF was 16% (n=493): 14% in decade 1; 19.3% in decade 2 and 15% in decade 3. On univariate analysis, most studied variables included in table 1 were statistically significant as predictors of DGF. However, on multivariate analysis, we found that in the first decade the predominant risk factors for DGF were pre-transplant dialysis time and cold-ischemia time, whilst in the following decades donor characteristics, as well as recipient’s weight became more relevant (table 2). Conclusion The observed shift from donor-unrelated variables in the first decade into donor-related variables in the second and third decades as the main determinants of DGF highlights the impact of expanding donor’s acceptance criteria. Nevertheless, the increase in expanded criteria donors did not translate into poorer overall results, probable contributors being shorter cold-ischemia times and stronger immunosuppression.

scholarly journals Endostatin Is an Independent Risk Factor of Graft Loss after Kidney Transplant

2020 ◽  
Vol 51 (5) ◽  
pp. 373-380
Author(s):  
Chang Chu ◽  
Ahmed A. Hasan ◽  
Mohamed M.S. Gaballa ◽  
Shufei Zeng ◽  
Yingquan Xiong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Transplant ◽  
Cox Regression ◽  
Graft Loss ◽  
Kidney Graft ◽  
Operating Characteristics ◽  
Baseline Serum ◽  
Collagen Xviii ◽  
All Cause Mortality ◽  
The Impact

Background: Endostatin is a 20-kDa C-terminal fragment of collagen XVIII, known for its ability to inhibit the proliferation of capillary endothelial cells. Previous studies suggested that circulating endostatin independently predicts incident chronic kidney disease. However, the impact of endostatin on graft loss level in kidney transplant recipients (KTRs) remains unknown. Methods: We conducted a prospective observational cohort study in 574 maintenance KTRs. Patients were followed for kidney graft loss and all-cause mortality during a median follow-up of 48 months. Serum-, and urine-samples and clinical data were collected at baseline. Serum Endostatin concentration was analyzed by an ELISA. Results: Among 574 patients, 37 patients had graft loss and 62 patients died. For graft loss, the optimal cut-off value based on receiver operating characteristics analysis (area under the curve 0.79, 95% CI 0.71–0.86, p < 0.001) of endostatin was 147.3 pmol/L. Kaplan-Meier curves revealed that higher serum endostatin concentrations positively correlated with graft loss (p < 0.001). Multivariable Cox regression analyses showed that baseline endostatin concentrations were significantly associated with graft loss after adjusting for graft loss risk factors (adjusted hazard ratio [HR] 8.34; 95% CI 2.19–31.72; p = 0.002). The adjusted HRs for classical graft loss risk factors such as baseline estimated glomerular filtration rate and urinary protein excretion were lower (1.91 and 5.44, respectively). In contrast to graft loss, baseline endostatin concentrations were not associated with all-cause mortality. Conclusion: Increased serum endostatin at baseline is independently associated with the risk of graft loss in KTRs.

scholarly journals H-Y Antigen Incompatibility Not Associated with Adverse Immunologic Graft Outcomes: Deceased Donor Pair Analysis of the OPTN Database

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Douglas Scott Keith ◽  
James T. Patrie
Keyword(s):  
Acute Rejection ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Graft Failure ◽  
Organ Procurement ◽  
Deceased Donor ◽  
Kidney Graft ◽  
The Difference ◽  
One Year ◽  
Deceased Donor Kidney Transplant

Background. H-Y antigen incompatibility adversely impacts bone marrow transplants however, the relevance of these antigens in kidney transplantation is uncertain. Three previous retrospective studies of kidney transplant databases have produced conflicting results.Methods. This study analyzed the Organ Procurement and Transplantation Network database between 1997 and 2009 using male deceased donor kidney transplant pairs in which the recipient genders were discordant. Death censored graft survival at six months, five, and ten years, treated acute rejection at six months and one year, and rates of graft failure by cause were the primary endpoints analyzed.Results. Death censored graft survival at six months was significantly worse for female recipients. Analysis of the causes of graft failure at six months revealed that the difference in death censored graft survival was due primarily to nonimmunologic graft failures. The adjusted and unadjusted death censored graft survivals at five and ten years were similar between the two genders as were the rates of immunologic graft failure. No difference in the rates of treated acute rejection at six months and one year was seen between the two genders.Conclusions. Male donor to female recipient discordance had no discernable effect on immunologically mediated kidney graft outcomes in the era of modern immunosuppression.

scholarly journals O6: EARLY ANASTOMOTIC BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
SJ Tingle ◽  
ER Thompson ◽  
SS Ali ◽  
IK Ibrahim ◽  
E Irwin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Hospital Stay ◽  
Graft Survival ◽  
Cox Regression ◽  
Risk Groups ◽  
Biliary Complications ◽  
Anastomotic Strictures ◽  
Selection Of Variables ◽  
Independent Risk Factors

Abstract Introduction Biliary leaks and anastomotic strictures are common early biliary complications (EBC) following liver transplantation. However, their impact on outcomes remains controversial and poorly described. Method The NHS registry on adult liver transplantation between 2006 and 2017 was retrospectively reviewed (n=8304). Multiple imputations were performed to account for missing data. Adjusted regression models were used to assess predictors of EBC, and their impact on outcomes. 35 potential variables were included, and backwards stepwise selection enabled unbiased selection of variables for inclusion in final models. Result EBC occurred in 9.6% of patients. Adjusted cox regression revealed that EBCs have a significant and independent impact on graft survival (Leak HR=1.325; P=0.021, Stricture HR=1.514; P=0.002, Leak plus stricture HR=1.533; P=0.034) and patient survival (Leak HR=1.218; P=0.131, Stricture HR=1.578; P&lt;0.001, Leak plus stricture HR=1.507; P=0.044). Patients with EBC had longer median hospital stay (23 versus 15 days; P&lt;0.001) and increased chance for readmission within the first year (56% versus 32%; P&lt;0.001). On adjusted logistic regression the following were identified as independent risk factors for development of EBC: donation following circulatory death (OR=1.280; P=0.009), accessory hepatic artery (OR=1.324; P=0.005), vascular anastomosis time in minutes (OR=1.005; P=0.032) and ethnicity ‘other’ (OR=1.838; P=0.011). Conclusion EBCs prolong hospital stay, increase readmission rates and are independent risk factors for diminished graft survival and increased mortality in liver transplantation. We have identified factors that increase the likelihood of EBC occurrence; further research into interventions to prevent EBCs in these at-risk groups is vital to improve liver transplantation outcomes. Take-home message Using a large registry database we have shown that early anastomotic biliary complications are independent risk factors for decreased graft survival and increased mortality after liver transplantation. Research into interventions to prevent biliary complications in high risk groups are essential to improve liver transplant outcomes.

Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes

2021 ◽  
pp. CJN.03290321
Author(s):  
Simon Ville ◽  
Marine Lorent ◽  
Clarisse Kerleau ◽  
Anders Asberg ◽  
Christophe Legendre ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Ischemia Reperfusion ◽  
Multivariable Analysis ◽  
Graft Function ◽  
Deceased Donor ◽  
Kidney Graft ◽  
Kidney Transplant Recipients ◽  
Heart Beating ◽  
Deceased Donor Kidney Transplant

BackgroundThe recognition that metabolism and immune function are regulated by an endogenous molecular clock generating circadian rhythms suggests that the magnitude of ischemia-reperfusion and subsequent inflammation on kidney transplantation, could be affected by the time of the day. MethodsAccordingly, we evaluated 5026 first kidney transplant recipients from deceased heart-beating donors. In a cause-specific multivariable analysis, we compare delayed graft function (DGF) and graft survival according to the time of kidney clamping and declamping. Participants were divided into clamping between midnight and noon (AM clamping group, 65%) or clamping between noon and midnight (PM clamping group, 35%), and similarly, AM declamping or PM declamping (25% / 75%). ResultsDGF occurred among 550 participants (27%) with AM clamping and 339 (34%) with PM clamping (adjusted OR = 0.81, 95%CI: 0.67 to 0.98, p= 0.03). No significant association of clamping time with overall death censored graft survival was observed (HR = 0.92, 95%CI: 0.77 to 1.10, p= 0.37). No significant association of declamping time with DGF or graft survival was observed. ConclusionsClamping between midnight and noon was associated with a lower incidence of DGF whilst the declamping time was not associated with kidney graft outcomes.

scholarly journals The Effect of Inhalational Anaesthesia during Deceased Donor Organ Procurement on Post-Transplantation Graft Survival

2018 ◽  
Vol 46 (2) ◽  
pp. 178-184 ◽  
Author(s):  
S. Perez-Protto ◽  
R. Nazemian ◽  
M. Matta ◽  
P. Patel ◽  
K. J. Wagner ◽  
...  
Keyword(s):  
Graft Survival ◽  
Organ Procurement ◽  
Survival Rates ◽  
Deceased Donor ◽  
Recovery Phase ◽  
Organ Donors ◽  
Post Transplantation ◽  
Ischaemia Reperfusion Injury ◽  
Definitive Answer ◽  
Medical Histories

Many deceased by neurologic criteria donors are administered inhalational agents during organ recovery surgery—a process that is characterised by warm and cold ischaemia followed by warm reperfusion. In certain settings, volatile anaesthetics (VA) are known to precondition organs to protect them from subsequent ischaemia–reperfusion injury. As such, we hypothesised that exposure to VA during organ procurement would improve post-graft survival. Lifebanc (organ procurement organisation [OPO] for NE Ohio) provided the investigators with a list of death by neurologic criteria organ donors cared for at three large tertiary hospitals in Cleveland between 2006 and 2016—details about the surgical recovery phase were extracted from the organ donors’ medical records. De-identified data on graft survival were obtained from the United Network for Organ Sharing (UNOS). The collated data underwent comparative analysis based on whether or not VA were administered during procurement surgery. Records from 213 donors were obtained for analysis with 138 exposed and 75 not exposed. Demographics, medical histories, and organ procurement rates were similar between the two cohorts. For the primary endpoint, there were no significant differences observed in either early (30-day) or late (five-year) graft survival rates for kidney, liver, lung, or heart transplants. Our findings from this retrospective review of a relatively small cohort do not support the hypothesis that the use of VA during the surgical procurement phase improves graft survival. Reviews of larger datasets and/or a prospective study may be required to provide a definitive answer.

The impact of HLA-DR compatibility on cadaver kidney graft survival in a prospective study with special emphasis on the quality of typing

2008 ◽  
Vol 23 (2) ◽  
pp. 94-104 ◽  
Author(s):  
BODIL K. JAKOBSEN ◽  
ERIK LANGHOFF ◽  
PER PLATZ ◽  
LARS P. RYDER ◽  
JØRN HESS THAYSEN ◽  
...  
Keyword(s):  
Prospective Study ◽  
Graft Survival ◽  
Kidney Graft ◽  
Hla Dr ◽  
Cadaver Kidney ◽  
A Prospective Study ◽  
The Impact

scholarly journals One-year Versus Five-year Hospital Readmission after Ischemic Stroke and TIA

2018 ◽  
Author(s):  
Anna Therese Bjerkreim ◽  
Halvor Naess ◽  
Andrej Netland Khanevski ◽  
Lars Thomassen ◽  
Ulrike Waje-Andreassen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Functional Outcome ◽  
Cox Regression ◽  
Index Admission ◽  
Unplanned Readmission ◽  
Cardiovascular Comorbidity ◽  
Factors Associated ◽  
Artery Disease ◽  
One Year

Abstract Background: The burden of readmission after stroke is substantial, but little knowledge exists on factors associated with long-term readmission after stroke. In a cohort composing patients with ischemic stroke and transient ischemic attack (TIA), we examined and compared factors associated with readmission within 1 year and first readmission during year 2-5. Methods: Patients with ischemic stroke or TIA who were discharged alive between July 2007 and October 2012, were followed for five years by review of medical charts. Timing and cause of the first unplanned readmission were registered. Cox regression was used to identify independent risk factors for readmission within 1 year and first readmission during year 2-5 after discharge. Results: The cohort included 1453 patients, of whom 568 (39.1%) were readmitted within 1 year. Of the 830 patients that were alive and without readmission 1 year after discharge, 439 (52.9%) were readmitted within 5 years. Patients readmitted within 1 year were older, had more severe strokes, poorer functional outcome, and a higher occurrence of complications during index admission than patients readmitted during years 2-5. Cardiovascular comorbidity did not differ between the two groups of readmitted patients. Higher age, poorer functional outcome, coronary artery disease and hypertension were independently associated with first readmission within both 1 year and during year 2-5. Peripheral artery disease was independently associated with readmission within 1 year, and atrial fibrillation was associated with first readmission during year 2-5. Conclusions: More than half of all patients who survived the first year after stroke without any readmissions were readmitted within 5 years. Patients readmitted within 1 year and between years 2-5 shared many risk factors for readmission, but they differed in age, functional outcome and occurrence of complications during the index admission.

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