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.

MO998EARLY VERSUS LATE ACUTE GRAFT PYELONEPHRITIS: A RETROSPECTIVE ANALYSIS OF GRAFT AND PATIENT OUTCOMES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Anupma Kaul ◽  
Thomas Mathews
Keyword(s):  
Renal Transplant ◽  
Graft Survival ◽  
Patient Survival ◽  
Univariate Analysis ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kaplan Meier ◽  
Baseline Characteristics ◽  
Acute Graft

Abstract Background and Aims Acute graft pyelonephritis(AGPN) is thought to affect graft and patient survival among renal transplant recipients. Our objective was to compare these outcomes in those having early AGPN(<6 months from transplant) versus those having late AGPN(>6months from transplant) Method This retrospective study analyzed 150 patients who had AGPN over a period of 8 years from 2005 to 2013. They were divided into early AGPN group and late AGPN group. Their baseline characteristics were compared. Predictors of graft loss and mortality were compared using logistic regression analysis. Graft survival and patient survival were analyzed using Kaplan-Meyer survival plots Results A total of 150 patients with AGPN were analyzed. Of these 55.3% (n=83) had early AGPN and 44.7% (n=67) had late AGPN. These two groups were comparable regarding baseline characteristics and immunosuppression. In early AGPN group, 13.3% (n=11) patients had CMV disease during follow up compared to 3% (n=2) in late AGPN group(p<0.05). In the early AGPN group, 26.5% (n=22) had prolonged Foley’s catheterization (>5days) following transplant surgery compared to 7.5% (n=5) in late AGPN group (p<0.05). In the early AGPN group, 38.6% (n=32) had prolonged DJ stent in-situ (>2weeks) following transplant surgery compared to 19.4% (n=13) in the late AGPN group (p<0.05). Recurrent GPN was more common in the late AGPN group than the early AGPN group - 35.8% (n=24) versus 18.1% (n=15). Predictors for graft loss were assessed in patients with AGPN and the presence of renal abscess was predictive of graft loss in univariate analysis (HR-6.129, 95% CI 1.776–21.154, p-0.004). There were no significant predictors of mortality in univariate analysis. Kaplan Meier survival analysis showed decreased death censored graft survival in the early AGPN group (p-0.035). There was no Conclusion Occurrence of early AGPN had a significant impact on long term graft survival in renal transplant recipients with no significant effect on patient survival. This study underlines the paramount importance of the prevention of UTIs in renal transplant recipients.

scholarly journals Haptoglobin 2-2 Genotype, Patient, and Graft Survival in Renal Transplant Recipients

2017 ◽  
Vol 27 (4) ◽  
pp. 386-391
Author(s):  
Laust Dupont ◽  
Ivar Anders Eide ◽  
Anders Hartmann ◽  
Jeppe Hagstrup Christensen ◽  
Anders Åsberg ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Graft Survival ◽  
Cardiovascular Mortality ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Genotype 2 ◽  
Haptoglobin Genotype

Background: Cardiovascular disease is the leading cause of death in renal transplant recipients. An association between haptoglobin genotype 2-2 and cardiovascular disease has been found in patients with diabetes mellitus and liver transplant recipients. To date, the role of haptoglobin genotype after renal transplantation has not been studied. Methods: In this single-center retrospective cohort study of 1975 adult Norwegian transplant recipients, who underwent transplantation between 1999 and 2011, we estimated the risk of all-cause and cardiovascular mortality and overall and death-censored graft loss for patients with haptoglobin genotype 2-2 compared to genotype 2-1 or 1-1, after adjustment for confounders and competing risks. Results: We found no associations between haptoglobin genotype 2-2 and cardiovascular mortality (subdistributional hazard ratio 1.08, 95% confidence interval 0.78-1.49; P = .63). We also failed to detect any association between haptoglobin 2-2 genotype and all-cause mortality, overall graft loss, and death-censored graft loss. Similar results were found in the subpopulation of transplant recipients with diabetes. Conclusion: In this large cohort of kidney transplant recipients, we could not demonstrate any association between haptoglobin 2-2 genotype and patient or graft survival after renal transplantation.

scholarly journals P1767ERALY VERSUS LATE GRAFT PYELONEPHRITIS- A RETROSPECTIVE ANALYSIS OF GRAFT AND PATIENT OUTCOME

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anupma Kaul ◽  
Thomas Mathews ◽  
Dharmendra Bhaduria ◽  
Narayan Prasad ◽  
Amit Gupta
Keyword(s):  
Renal Transplant ◽  
Graft Survival ◽  
Patient Survival ◽  
Univariate Analysis ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Significant Difference ◽  
Dj Stent ◽  
Baseline Characteristics

Abstract Background and Aims Acute graft pyelonephritis(AGPN) is thought to affect the graft and patient survival among the renal transplant recipients.Our objective was to compare these outcomes in those having early AGPN(<6 months from transplant) versus those having late AGPN(>6months from transpant) Method This retrospective study analysed 150 patients who had AGPN over a period of 8 years from 2005 to 2013.They were divided into early AGPN group and late AGPN group .Their baseline characteristics were compared.Predictors of graftloss and mortality were compared using logistic regression analysis.Graft survival and patient survival wereanalysed using Kaplan-Meyer survival plots Results A total of 150 patients with AGPN were analysed.Of these 55.3%(n=83) had early AGPN and 44.7%(n=67) had late AGPN.These two groups were comparable regarding baseline characteristics and immunosuppression.13.3%(n=11) patients in early AGPN group had CMV disease during follow up compared to 3%(n=2) in late AGPN group(p<0.05).26.5%(n=22) in the early AGPN group had prolonged foley’s catheterization(>5days) following transplant surgery compared to 7.5%(n=5) in late AGPN group(p<0.05).38.6%(n=32) in the early AGPN group had prolonged DJ stent in-situ(>2weeks) following transplant surgery compared to 19.4%(n=13) in the late AGPN group(p<0.05).Recurrent GPN was more common in the late AGPN group than the early AGPN group-35.8%(n=24) verus 18.1%(n=15).Predictors for graft loss was assessed in patients with AGPN and presence of renal abscess was predictive of graft loss in univariate analysis(HR-6.129 ,95 % CI 1.776-21.154,p-0.004).There were no significant predictors of mortality in univariateanalysis.KaplanMeiyer survival analysis showed decreased death censored graft survival in the early AGPN group(p-0.035).There was no significant difference in the patient survival among two groups. Conclusion Occurrence of early AGPN has significant impact on long term graft survival in renal transplant recipients with no significant effect on patient survival.This study underlines the paramount importance of prevention of UTIs in renal transplant recipients.

scholarly journals Outcomes of Kidney Transplant Recipients with Sickle Cell Disease: An Analysis of the 2000–2019 UNOS/OPTN Database

2021 ◽  
Vol 10 (14) ◽  
pp. 3063
Author(s):  
Napat Leeaphorn ◽  
Charat Thongprayoon ◽  
Pradeep Vaitla ◽  
Panupong Hansrivijit ◽  
Caroline C. Jadlowiec ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Patient Survival ◽  
Transplant Recipients ◽  
Cell Disease ◽  
Kidney Transplant Recipients ◽  
Allograft Survival ◽  
End Stage Kidney Disease ◽  
Kidney Recipients ◽  
End Stage

Background: Lower patient survival has been observed in sickle cell disease (SCD) patients who go on to receive a kidney transplant. This study aimed to assess the post-transplant outcomes of SCD kidney transplant recipients in the contemporary era. Methods: We used the OPTN/UNOS database to identify first-time kidney transplant recipients from 2010 through 2019. We compared patient and allograft survival between recipients with SCD (n = 105) vs. all other diagnoses (non-SCD, n = 146,325) as the reported cause of end-stage kidney disease. We examined whether post-transplant outcomes improved among SCD in the recent era (2010–2019), compared to the early era (2000–2009). Results: After adjusting for differences in baseline characteristics, SCD was significantly associated with lower patient survival (HR 2.87; 95% CI 1.75–4.68) and death-censored graft survival (HR 1.98; 95% CI 1.30–3.01), compared to non-SCD recipients. The lower patient survival and death-censored graft survival in SCD recipients were consistently observed in comparison to outcomes of recipients with diabetes, glomerular disease, and hypertension as the cause of end-stage kidney disease. There was no significant difference in death censored graft survival (HR 0.99; 95% CI 0.51–1.73, p = 0.98) and patient survival (HR 0.93; 95% CI 0.50–1.74, p = 0.82) of SCD recipients in the recent versus early era. Conclusions: Patient and allograft survival in SCD kidney recipients were worse than recipients with other diagnoses. Overall SCD patient and allograft outcomes in the recent era did not improve from the early era. The findings of our study should not discourage kidney transplantation for ESKD patients with SCD due to a known survival benefit of transplantation compared with remaining on dialysis. Urgent future studies are needed to identify strategies to improve patient and allograft survival in SCD kidney recipients. In addition, it may be reasonable to assign risk adjustment for SCD patients.

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.

Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology follow-up matter?

2016 ◽  
Vol 18 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Naveed Ul Haq ◽  
Mohamed Said Abdelsalam ◽  
Mohammed Mahdi Althaf ◽  
Abdulrahman Ali Khormi ◽  
Hassan Al Harbi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Clinic Visit ◽  
Study Data ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Early Referral ◽  
Period Data ◽  
Stage Renal Disease ◽  
End Stage

Background Native arteriovenous fistulae (AVFs) are preferred while central venous catheters (CVCs) are least suitable vascular access (VA) in patients requiring hemodialysis (HD). Unfortunately, around 80% of patients start HD with CVCs. Late referral to nephrologist is thought to be a factor responsible for this. We retrospectively analyzed the types of VA at HD initiation in renal transplant recipients followed by nephrologists with failed transplant. If early referral to nephrologist improves AVF use, these patients should have higher prevalence of AVF at HD initiation. Methods All patients who failed their kidney transplants from January 2002 to April 2013 were included in the study. Data regarding planning of VA by nephrologist, documented discussion about renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) at 6 months and last clinic visit before HD initiation, time of VA referral, and subsequent VA at dialysis initiation were gathered and analyzed. Results Eighty-three patients failed their transplants during study period. Data were inaccessible in six patients. Eleven patients started peritoneal dialysis (PD) while 66 started HD. Thirty-two had previous functioning VA while 34 needed VA. There were 11/34 patients (32%) with eGFR <15 mL/min at six months while 21/34 (61%) had eGFR <15 mL/min at last clinic visit before HD initiation. Only 11/34 (32%) had documented RRT discussion, 8/34 (24%) had VA referral, and 7/34 (21%) had vein mapping. A total of 30/34 (88.3%) started HD with CVC while 4/34 (11.3%) started HD with AVF (p<0.0001). Conclusions Early referral to nephrologist by itself may not improve VA care amongst patient with end-stage renal disease.

Renal Transplantation in Systemic Lupus Erythematosus: Comparison of Graft Survival With Other Causes of End-stage Renal Disease

2019 ◽  
Vol 15 (3) ◽  
pp. 140-145
Author(s):  
Gabriel Horta-Baas ◽  
Adolfo Camargo-Coronel ◽  
Dafhne Guadalupe Miranda-Hernández ◽  
Leslie Gabriela Gónzalez-Parra ◽  
María del Socorro Romero-Figueroa ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Renal Transplantation ◽  
Renal Disease ◽  
Graft Survival ◽  
Lupus Erythematosus ◽  
End Stage Renal Disease ◽  
Systemic Lupus ◽  
Stage Renal Disease ◽  
End Stage

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.

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