scholarly journals Analysis of Risk Factors for Kidney Retransplant Outcomes Associated with Common Induction Regimens: A Study of over Twelve-Thousand Cases in the United States

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Alfonso H. Santos ◽  
Michael J. Casey ◽  
Karl L. Womer
Keyword(s):  
Risk Factors ◽  
Graft Loss ◽  
Deceased Donor ◽  
The United States ◽  
Patient Death ◽  
Adult Kidney ◽  
Induction Regimen ◽  
Expanded Criteria ◽  
One Year ◽  
Hla Mismatches

We studied registry data of 12,944 adult kidney retransplant recipients categorized by induction regimen received into antithymocyte globulin (ATG) (N = 9120), alemtuzumab (N = 1687), and basiliximab (N = 2137) cohorts. We analyzed risk factors for 1-year acute rejection (AR) and 5-year death-censored graft loss (DCGL) and patient death. Compared with the reference, basiliximab: (1) one-year AR risk was lower with ATG in retransplant recipients of expanded criteria deceased-donor kidneys (HR = 0.56, 95% CI = 0.35–0.91 and HR = 0.54, 95% CI = 0.27–1.08, resp.), while AR risk was lower with alemtuzumab in retransplant recipients with >3 HLA mismatches before transplant (HR = 0.63, 95% CI = 0.44–0.93 and HR = 0.81, 95% CI = 0.63–1.06, resp.); (2) five-year DCGL risk was lower with alemtuzumab, not ATG, in retransplant recipients of African American race (HR = 0.54, 95% CI = 0.34–0.86 and HR = 0.73, 95% CI = 0.51–1.04, resp.) or with pretransplant glomerulonephritis (HR = 0.65, 95% CI = 0.43–0.98 and HR = 0.82, 95% CI = 0.60–1.12, resp.). Therefore, specific risk factor-induction regimen combinations may predict outcomes and this information may help in individualizing induction in retransplant recipients.

scholarly journals The causes and frequency of kidney allograft failure in a low-resource setting: Data from Iraqi Kurdistan

2021 ◽  
Author(s):  
Alaa Abbas Ali ◽  
Safaa E Almukhtar ◽  
Kais H Abd ◽  
Zana Sidiq M Saleem ◽  
Dana A Sharif ◽  
...  
Keyword(s):  
Graft Failure ◽  
Interstitial Fibrosis ◽  
Graft Loss ◽  
The United States ◽  
Failure Rates ◽  
Antibody Mediated Rejection ◽  
Iraqi Kurdistan ◽  
Resource Setting ◽  
Long Term Treatment ◽  
One Year

Abstract Background In the developing world, transplantation is the most common long-term treatment for patients with end-stage renal disease, but rates and causes of graft failure are uncertain. Methods In 2019, in Iraqi Kurdistan, 301 of 871 renal transplant patients had indicated graft biopsies. Outcomes were followed over the subsequent year of 2020. Results The post-transplantation time ranged from one day to 18 years. All donors were living. Approximately 15% of transplants were preemptive. Pretransplant hemodialysis (HD) was twice weekly and less than one year. The median recipient age was 39 (IQR 28 to 48) years. 5.5% of recipients had previous transplants; 3.7% had pretransplant donor-specific antibodies (DSA). The Kaplan-Meier estimated graft failure rates for all-cause, return to HD, and death with functional graft (DWFG) were 9.1%, 6.3%, and 2.9% at one year and 23.8%, 6.3%, and 7.4% at five years. The median death-censored graft survival was 15 years. The most frequent biopsy diagnoses associated with graft failure were interstitial fibrosis and tubular atrophy (IF/TA) (23.1%), transplant glomerulopathy (13.7%), and acquired active antibody-mediated rejection (11.1%). The significant predictors of graft loss were C4d + biopsies (P < 0.01) and advanced IF/TA (P < 0.001). Conclusions These Iraqi patients had estimated graft failure rates similar to the United States (US) Renal Data System living-donor outcomes reported for the year 2000. The inability to approach recent US graft survivals may owe to inadequate pretransplant dialysis. Nevertheless, prolonged survival made chronic disorders and acquired DSA the leading causes of graft failure and is creating a need for second transplants.

scholarly journals Can PIRCHE-II Matching Outmatch Traditional HLA Matching?

2021 ◽  
Vol 12 ◽  
Author(s):  
Christian Unterrainer ◽  
Bernd Döhler ◽  
Matthias Niemann ◽  
Nils Lachmann ◽  
Caner Süsal
Keyword(s):  
Positive Impact ◽  
Graft Loss ◽  
Deceased Donor ◽  
Hla Typing ◽  
Hla Matching ◽  
Hla Antigen ◽  
Deceased Donor Kidney ◽  
Resolution Level ◽  
Kidney Transplantations ◽  
Hla Mismatches

We analyzed in a cohort of 68,606 first deceased donor kidney transplantations reported to the Collaborative Transplant Study whether an epitope-based matching of donor-recipient pairs using the Predicted Indirectly ReCognizable HLA Epitopes algorithm (PIRCHE-II) is superior to currently applied HLA antigen matching. PIRCHE-II scores were calculated based on split antigen HLA-A, -B, -DRB1 typing and adjusted to the 0–6 range of HLA mismatches. PIRCHE-II scores correlated strongly with the number of HLA mismatches (Spearman ρ = 0.65, P &lt; 0.001). In multivariable analyses both parameters were found to be significant predictors of 5-year death-censored graft loss with high prognostic power [hazard ratio (HR) per adjusted PIRCHE-II score = 1.102, per HLA mismatch = 1.095; z-value PIRCHE-II: 9.8, HLA: 11.2; P &lt; 0.001 for both]. When PIRCHE-II scores and HLA mismatches were analyzed simultaneously, their predictive power decreased but remained significant (PIRCHE-II: P = 0.002; HLA: P &lt; 0.001). Influence of PIRCHE-II was especially strong in presensitized and influence of HLA mismatches in non-sensitized recipients. If the level of HLA-incompatibility was low (0–3 mismatches), PIRCHE-II scores showed a low impact on graft survival (HR = 1.031) and PIRCHE-II matching did not have additional significant benefit (P = 0.10). However, if the level of HLA-incompatibility was high (4–6 mismatches), PIRCHE-II improved the positive impact of matching compared to applying the traditional HLA matching alone (HR = 1.097, P = 0.005). Our results suggest that the PIRCHE-II score is useful and can be included into kidney allocation algorithms in addition to HLA matching; however, at the resolution level of HLA typing that is currently used for allocation it cannot fully replace traditional HLA matching.

scholarly journals Short term and long term survival rate and risk factors of graft rejection after deceased donor kidney transplantation: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Seyed Mohammad Kazem Aghamir ◽  
Mohammad Saatchi
Keyword(s):  
Risk Factors ◽  
Survival Rate ◽  
Graft Rejection ◽  
Patient Survival ◽  
Meta Analysis ◽  
Deceased Donor ◽  
Patient Death ◽  
Short Term ◽  
Term Survival

Abstract The purpose of the current meta-analysis is to determine the short-term and long-term graft and patient survival after deceased donor (DD) transplantation, as well as to determine prognostic factors. Method : Articles published until March 2019 in PubMed, Scopus, and Google Scholar databases, reporting short-term and/or long term graft and patient survival were searched. In addition to this, we included articles that analyzed the hazard ratio (HR) of graft rejection and/or patient death caused by DD related risk factors. The summary measures of this study included the survival rate, the HR of graft rejection, and patient death in response to DD related risk factors. This study, which is the first comprehensive meta-analysis of graft and patient survival rates after transplantation from the deceased donor, showed that overall short and long-term survival of graft and patient is desirable. In addition to this, it confirms that ECD and DCD recipients have a lower graft survival rate than standard donors.

P1637UK KIDNEY ALLOCATION SCHEME: APPROPRIATE MATCHING BUT RESOURCE IMPLICATIONS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Eleanor Murray ◽  
Robert Pearson ◽  
Peter Thomson ◽  
Marc Clancy ◽  
John Asher
Keyword(s):  
Patient Survival ◽  
Risk Index ◽  
Graft Loss ◽  
Graft Function ◽  
Deceased Donor ◽  
First Year ◽  
Age Difference ◽  
Allocation Scheme ◽  
Endpoint Data ◽  
One Year

Abstract Background and Aims UK NHSBT kidney matching scheme changed in September 2019, aiming to better match graft and patient survival through stratification of donors and recipients into risk quartiles. We present data on two years of transplants aiming to highlight discrepancies between our unit and the model on which the scheme is based, and the potential implications on service provision of its’ introduction. Method We reviewed all deceased donor transplants in our centre in 2015 and 2016. Recipients and donors were re-classified into the risk index quartiles and endpoint data included inpatient days in first year, 1 year eGFR, survival, imaging, and infection episodes. Comparisons were made with NHSBT literature. Results 196 deceased donor transplants were performed. Distribution of D1-4 kidneys to R1-4 recipients in our cohort did not reflect those presented in the allocation scheme models, with our population skewed toward higher risk R4 category (73.4%), including 55 D4R4 (83% of D4 kidneys), see Figure 1. 2.0% had an age difference between donor and recipient of &gt;25years, and 12.8% 15-25 years, compared with the NHSBT proposed targets of 8% and 20% respectively. Within the R4 group, recipients receiving a D4 graft were associated with a higher rate of DGF (41.7%, vs 23.2% D1-D3 grafts, p=0.009), longer index admission (median 11 days vs 8 days, p=0.038) and more readmissions within the first post-operative year (median 18 vs 11 days, p = 0.005) – Figure 2. D4 grafts demonstrated lower mean eGFR at one year (35.7, vs. 54.8 ml/min, p&lt;0.001), Figure 3. R4 recipients experienced graft loss more frequently (HR 3.4 vs R1-3 (95%CI 0.8-13.9, p=0.12). One-year survival in R4 cohort was 97.8% (four deaths), and 93.8% at 4 years; R1-3 cohort had 100% survival to 4 years; there was no significant impact on R4 patient survival with D4 kidneys vs. D1-D3. Day ward attendances, bacteraemia, and CT imaging events did not differ by R or D category; D4 was associated with higher rates of transplant ultrasound (5.6 vs R1-3 4.25, p=0.009), and R4 with higher rates of urinary tract infection (3.6 vs R1-3 1.5, p=0.03). Conclusion Firstly, our transplant population is weighted to higher risk R4 recipients; secondly, intended principals of the allocation scheme are already largely being observed. Thirdly, our data does suggest that increasing R4D4 transplants will have a significant impact on transplant centres, with resource burden primarily within the first year. But despite poorer graft function, patient survival appears to be equivalent and improved matching may in the longer term reduce need for re-implantation as the scheme intends.

Abstract P699: Trends in Ischemic Stroke Risk Factors and Outcomes in a Rural Population in the United States

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Durgesh Chaudhary ◽  
Ayesha Khan ◽  
Shima Shahjouei ◽  
Mudit Gupta ◽  
Clare Lambert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Stroke Recurrence ◽  
Stroke Mortality ◽  
One Year ◽  
The One

Introduction: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the trends in stroke risk factors and outcomes among a rural population in the United States between 2004 and 2018. Methods: We built a comprehensive stroke database called “Geisinger NeuroScience Ischemic Stroke (GNSIS)” for this study. Clinical data were extracted from multiple sources, including electronic health records and quality data. Results: Our cohort comprised of 8,561 consecutive ischemic stroke patients (mean age: 70.1±13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The rate of hypertension, diabetes, dyslipidemia, and history of stroke increased significantly over the fifteen years window. The one-year recurrence and mortality rates were 6.3% and 15.8%, respectively. Although the one-year stroke recurrence increased from 2004 to 2018 (Cochran-Armitage test Z = -3.66, p<0.001), the one-year stroke mortality rate decreased significantly (Cochran-Armitage test Z = 2.39, p=0.008). Age >65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Fine-Gray competing risk model, diabetes mellitus and age <65 years was found to be associated with one-year ischemic stroke recurrence. In the logistic regression, chronic kidney disease (CKD), diabetes, and prior ischemic stroke were predictors of one-year recurrence while age >65 years, atrial fibrillation or flutter, CKD, heart failure, prior hemorrhagic and ischemic stroke, history of neoplasm, myocardial infarction, and rheumatic diseases were predictors of one-year mortality. Conclusion: Although stroke mortality has decreased, stroke recurrence and several vascular risk factors have significantly increased in our rural population between 2004-2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes mellitus and age less than 65 years were predictors of ischemic stroke recurrence.

Dispelling the myth of Asian homogeneity: Improved outcomes of Chinese Americans after kidney transplantation

2018 ◽  
Vol 3 ◽  
pp. 5-9
Author(s):  
Farah Karipineni ◽  
Afshin Parsikia ◽  
PoNan Chang ◽  
John Pang ◽  
Stalin Campos ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Patient Survival ◽  
Graft Loss ◽  
Graft Function ◽  
Chinese Americans ◽  
The United States ◽  
Chinese Patients ◽  
One Year ◽  
Patient And Graft Survival

Objectives: Asians represent the fastest growing ethnic group in the United States. Despite significant diversity within the group, many transplant studies treat Asians as a homogeneous entity. We compared patient and graft survival among major Asian eth- nicities to determine whether any subgroup has superior out- comes. Methods: We conducted a retrospective analysis of kidney trans- plants on Asian and White patients between 2001 and 2012. Co- variates included gender, age, comorbidities, and donor category. Primary outcomes included one-year patient and graft survival. Secondary outcomes included delayed graft function (DGF) and rejection as cause of graft loss and death. Results: Ninety-one Asian patients were identified. Due to the large proportion of Chinese patients (n=37), we grouped other Asians into one entity (n=54) for statistical comparison among Chinese, other Asians, and Whites (n=346). Chinese subjects had significantly lower body mass index (BMI) (p=0.001) and had the lowest proportion of living donors (p>0.001). Patient survival was highest in our Chinese cohort (p>0.001)Discussion: Our study confirms outcome differences among Asian subgroups in kidney transplantation. Chinese demonstrate better patient survival at one year than Whites and non-Chinese Asians despite fewer live donors. Lower BMI scores may partly explain this. Larger, long-term studies are needed to elucidate outcome disparities among Asian subgroups

scholarly journals Aplicação retrospectiva dos escores KDPI e EPTS em pacientes de um Centro de Transplantes Brasileiro / Retrospective application of the KDPI and EPTS scores in patients from a Brazilian Transplant Center

2020 ◽  
Vol 65 (1) ◽  
pp. 1
Author(s):  
Luana Costa de Aguiar ◽  
Bruma Baptista ◽  
Arthur Ferraz Jong Mun Lee ◽  
Filipe Bissoli ◽  
Vinícius Bortoloti Péterle ◽  
...  
Keyword(s):  
Loss Rate ◽  
Graft Loss ◽  
The United States ◽  
Kidney Transplants ◽  
The North ◽  
Kidney Recipients ◽  
Transplant Center ◽  
Deceased Donors ◽  
One Year

Introdução: KDPI e EPTS são escores implantados nos Estados Unidos em 2014 para guiar a alocação de enxertos renais. O objetivo deste trabalho é correlacionar valores desses escores com desfechos dos transplantes renais realizados em um Centro de Transplantes brasileiro, avaliando sua capacidade de predizer prognóstico nesta população. Métodos: Estudo observacional, individuado, longitudinal e retrospectivo com 163 pares receptor-doador de transplantes renais com doadores falecidos, realizados entre 2012 e 2017, com acompanhamento até 2019. Resultados: Pacientes com enxertos de KDPI menor ou igual à mediana obtiveram menor mortalidade após um ano (p = 0,02); menor taxa de perda de enxerto até um ano (p = 0,00) e após um ano (p = 0,03) e menor nível de creatinina (p = 0,00). Receptores com EPTS menor ou igual à mediana obtiveram taxa de perda de enxerto significativamente menor, se comparados aos com valores acima da mediana (p = 0,01). O coeficiente de correlação entre KDPI e EPTS foi da ordem de 0,016 (p = 0,84). Conclusão: O KDPI evidenciou-se como ferramenta objetiva e de fácil aplicação para predizer prognóstico e, assim, direcionar os rins a serem transplantados. O EPTS mostrou caráter promissor para avaliação dos receptores renais. Esses dados podem ser complementados com futuros estudos nacionais para possível validação e implementação dos escores no país. Conclusão: Por fim, observou-se que não houve correlação direta entre os valores de KDPI do enxerto com os valores de EPTS de seus receptores, distanciando-se do que é preconizado pela literatura norte-americana.Palavras Chave: Transplante de rim, Seleção de doadores, Sobrevivência de enxertoABSTRACTIntroduction: KDPI and EPTS are scores implemented in the United States in 2014 to guide the allocation of kidney grafts. The objective of this work is to correlate values of these scores with outcomes of kidney transplants performed in a Brazilian Transplant Center, evaluating their ability to predict prognosis in this population. Methods: Observational, individual, longitudinal and retrospective study with 163 recipient-donor pairs of kidney transplants with deceased donors, carried out between 2012 and 2017, with follow-up until 2019. Results: Patients with grafts with KDPI less than or equal to the median had lower mortality after one year (p = 0.02); lower graft loss rate up to one year (p = 0.00) and after one year (p = 0.03) and lower creatinine level (p = 0.00). Recipients with EPTS less than or equal to the median had a significantly lower graft loss rate, compared to those with values greater than the median (p = 0.01). The correlation coefficient between KDPI and EPTS was of about 0.016 (p = 0.84). Conclusion: KDPI proved to be an objective and easy to apply tool to predict prognosis and, thus, direct the kidneys to be transplanted. EPTS showed a promising character for the evaluation of kidney recipients. These data can be complemented with future national studies for possible validation and implementation of such scores in the country. Conclusion: Finally, it was observed that there was no direct correlation between the KDPI values of grafts and the EPTS values of its recipients, distancing from what is recommended by the North American literature.Keywords: Kidney transplantation, Donor selection, Graft survival

The Washington, D.C. Experience with Uncontrolled Donation after Circulatory Determination of Death: Promises and Pitfalls

2008 ◽  
Vol 36 (4) ◽  
pp. 735-740 ◽  
Author(s):  
Jimmy A. Light
Keyword(s):  
Organ Procurement ◽  
Organ Donor ◽  
Deceased Donor ◽  
The United States ◽  
Demand And Supply ◽  
Deceased Donor Kidney ◽  
Donor Population ◽  
History Of ◽  
Expanded Criteria

As of January 1, 2008, over 98,000 people are waiting for organ transplants in the United States of America. Of those, nearly 75,000 are waiting for a kidney. In this calendar year, fewer than 15,000 will receive a kidney transplant from a deceased donor. The average waiting time for a deceased donor kidney now exceeds five years in virtually all metropolitan areas. Sadly, nearly as many people die waiting as there are deceased donors each year, despite monumental efforts by the entire transplant community to increase both the number of organ donors and the number of organs recovered from each donor. The imbalance between demand and supply has led to considerable efforts to expand the criteria for what is considered an acceptable organ donor by the Organ Procurement and Transplant Network (OPTN), thereby hoping somewhat to assuage the shortfall of donor organs. So-called Expanded Criteria Donors (ECDs) may be older than 50, have history of hypertension, or have died from intracerebral hemorrhage and/or have impaired renal function. ECDs now make up nearly 40% of the donor population.

scholarly journals The Effect of Posttransplantation Diabetes Mellitus on the Prognosis of Transplantation: a Prospective Cohort Study

2019 ◽  
Author(s):  
Hang Zhou ◽  
Xiaoqian Yang ◽  
Liang Ying ◽  
Xiaodong Yuan ◽  
Yuehan Wei ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Bacterial Infection ◽  
Graft Failure ◽  
Graft Loss ◽  
Graft Function ◽  
Renal Transplant Recipients ◽  
Risk Of Death ◽  
Independent Risk Factors ◽  
One Year

Abstract Background: Posttransplantation diabetes mellitus (PTDM) constitutes one of the most important complications associated with kidney transplantation and is associated with significant morbidity and mortality. Methods: This study was a single-centred prospective observational study that included 310 consecutive renal transplant recipients. The primary end point was graft failure, including death-censored graft failure and mortality. The secondary endpoints include estimated glomerular filtration rate (eGFR) at 12 months and adverse events after transplantation. The prevalence rate of PTDM and relevant risk factors for PTDM were also explored. Results: The incidence of PTDM was 16.4% within one year. Death-censored graft loss rate differed significantly between recipients without PTDM and those with PTDM(0.77% versus 12%, p<0.001). Compared with non-PTDM group, the mean eGFR was significantly lower in the PTDM group(70.55±20.54 ml/min·1.73 m² versus 63.04±21.92 ml/min·1.73 m², P=0.03). Additionally, compared with the other group, the PTDM group was more easily infected by bacteria(16.2% versus 40%, P<0.001). Multi-factor analysis indicated that higher preoperative fasting plasma glucose (FPG), increased age and use of tacrolimus after transplantation were independent risk factors for PTDM. Conclusion: The incidence rate of PTDM is 16.4% 1 year after surgery. Our study suggests that patients with PTDM are at higher risk of death-censored graft loss and bacterial infection, and worse kidney function. Independent risk factors of PTDM include preoperative FPG level, increased age, and tacrolimus. The PTDM group is more vulnerable to worse graft function, postoperative graft loss and bacterial infection.

scholarly journals Risk Factors for Early Pancreatic Allograft Thrombosis Following Simultaneous Pancreas-Kidney Transplantation: A Systematic Review

2020 ◽  
Vol 26 ◽  
pp. 107602962094258
Author(s):  
Jian Blundell ◽  
Sara Shahrestani ◽  
Rebecca Lendzion ◽  
Henry J. Pleass ◽  
Wayne J. Hawthorne
Keyword(s):  
Risk Factors ◽  
Cohort Studies ◽  
Data Extraction ◽  
Graft Loss ◽  
Deceased Donor ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Increased Risk ◽  
Simultaneous Pancreas Kidney ◽  
Pancreas Allograft

Simultaneous pancreas-kidney (SPK) transplantation remains the most effective treatment for providing consistent and long-term euglycemia in patients having type 1 diabetes with renal failure. Thrombosis of the pancreatic vasculature continues to contribute significantly to early graft failure and loss. We compared the rate of thrombosis to graft loss and systematically reviewed risk factors impacting early thrombosis of the pancreas allograft following SPK transplantation. We searched the MEDLINE, EMBASE, The Cochrane Library, and PREMEDLINE databases for studies reporting thrombosis following pancreas transplantation. Identified publications were screened for inclusion and synthesized into a data extraction sheet. Sixty-three studies satisfied eligibility criteria: 39 cohort studies, 22 conference abstracts, and 2 meta-analyses. Newcastle-Ottawa Scale appraisal of included studies demonstrated cohort studies of low bias risk; 1127 thrombi were identified in 15 936 deceased donor, whole pancreas transplants, conferring a 7.07% overall thrombosis rate. Thrombosis resulted in pancreatic allograft loss in 83.3% of reported cases. This review has established significant associations between donor and recipient characteristics, procurement and preservation methodology, transplantation technique, postoperative management, and increased risk of early thrombosis in the pancreas allograft. Further studies examining the type of organ preservation fluid, prophylactic heparin protocol, and exocrine drainage method and early thrombosis should also be performed.

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