Nationwide Outcomes after Renal Transplantation from Kidney-Only versus Multiple-Organ Deceased Donors

To assess renal transplant outcomes after donation by kidney-only (KO) versus multiple-organ (MO) donors on a national scale. The United Network for Organ Sharing database was examined for patients undergoing isolated kidney transplant from a deceased donor from 2000 through 2016. Comparison was made between recipients of grafts from KO versus MO donors at baseline and in a cohort of KO and MO recipients matched via propensity scoring. Outcomes of interest included delayed graft function (DGF), patient survival, and the cumulative incidence of graft loss. There were 33,326 recipients in the KO cohort versus 144,690 in the MO cohort. Donation after cardiac death donors were more prevalent in the KO group (43.8% vs 5.3%; P < 0.001). DGF occurred in 36.1 per cent of the KO versus 22.7 per cent of the MO recipients ( P < 0.001). Five-year survival was 79.5 per cent versus 83.4 per cent ( P < 0.001) in the KO versus MO group. After propensity matching, DGF was still more common in the KO group (33.1% vs 30.1%; P < 0.001). Patient survival was similar (79.5% KO vs 80.1% MO; P = 0.117). Cumulative incidence of graft loss was higher in the KO group (17.8% vs 16.8%). Survival outcomes from KO donors are actually quite good and should not be considered as inferior to MO donors.

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P1637UK KIDNEY ALLOCATION SCHEME: APPROPRIATE MATCHING BUT RESOURCE IMPLICATIONS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1637 ◽

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 >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<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.

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Machine Retrograde Perfusion of Deceased Donor Kidneys: A Prospective Study

Frontiers in Medicine ◽

10.3389/fmed.2021.785953 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jun Zeng ◽

ZiHao Jia ◽

Tao Lin ◽

TuRun Song

Keyword(s):

Estimated Glomerular Filtration Rate ◽

Graft Function ◽

Deceased Donor ◽

Control Group ◽

Lower Serum ◽

Safe Alternative ◽

Kidney Preservation ◽

Retrograde Perfusion ◽

Deceased Donors ◽

A Prospective Study

Objective: To maximize the utilization of potential kidneys, improving perfusion and preservation techniques is necessary.Methods: We investigated the safety and efficacy of retrograde machine perfusion of kidneys from deceased donors. A total of 30 kidneys were included and all the grafts were preserved in the Kidney Transporter machines. A total of 15 kidneys that received retrograde perfusion (RP) were selected as the RP group (n = 15) and their counterparts received standard antegrade perfusion (AP) as the control group (n = 15).Results: All the recipients were followed up for 6 months. Renal resistance in the RP group remained stable during the perfusion. There was no primary nonfunction. No difference in the incidence of delayed graft function was found in both groups (3 in RP vs. 2 in AP, p = 0.62). The RP group had lower serum creatinine (RP vs. AP, 102.20 vs. 138.67, p = 0.05) and blood urea nitrogen (RP vs. AP, 6.44 vs. 8.71, p = 0.05) than that in the AP group at 6 months. Both the groups had comparable estimated glomerular filtration rate and cystatin C within 6 months.Conclusion: This novel technique may be an effective and safe alternative for kidney preservation.

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Results of Deceased Donor Kidney Transplantation in Young Recipients after Age-matched and Mismatched (Old-to-young) Transplantation

Acta Chirurgica Latviensis ◽

10.1515/chilat-2017-0002 ◽

2016 ◽

Vol 16 (2) ◽

pp. 8-11

Author(s):

Janis Jushinskis ◽

Vadims Suhorukovs ◽

Aleksandrs Malcevs ◽

Ieva Ziedina ◽

Rafails Rozentals

Keyword(s):

Graft Function ◽

Deceased Donor ◽

Rejection Rate ◽

Donor Age ◽

Donor Kidney ◽

Deceased Donor Kidney ◽

Significant Difference ◽

Deceased Donors ◽

Kidney Transplantations

SummaryIntroduction.During the previous years the number of organ transplantations from elderly donors increased, and lack of young donors leads to necessity to allocate organs from elderly into young recipients.Aim of the Study.Was to analyse results of “old-to-young” allocation.Material and methods.This retrospective study analysed results of all consecutive deceased donor kidney transplantations (DDKT) performed in one transplant centre during the period from 01.01.2004 till 31.12.2007. Patients were selected based on availability of 5-year follow-up and age < 50 years (158 DDKT). Patients were divided into 2 groups according to donor age: age-mismatched group (donor age was > 55 years and at the same time > 15 years older than recipient; n=8, male/female=2/6, age 39,4 + 4,8 years, donor age 59,4 + 2,4 years), and age-matched group (n=150, male/female=88/62, age 36,0 + 11,0 years, donor age 37,3 + 12,0 years). Groups were compared for clinical and demographical features and posttransplant outcomes (delayed graft function, s-creatinin levels at discharge and after 5 years, acute rejection rate, graft and patient 5-year survival).Results.Comparison of demographical and clinical features revealed only relatively higher BMI in elderly donors (p=0.081) and higher frequency of age-mismatched allocation into female recipients (p=0.066). Early and late post-transplant outcomes showed no significant difference between groups, with similar 5-year graft and patient survival (p=NS for all compared factors).Conclusion.Results showed good kidney allograft function even in cases of age-mismatched allocation, which is significant opportunity in current situation with increasing age of deceased donors.

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

Translation: The University of Toledo Journal of Medical Sciences ◽

10.46570/utjms.vol3-2016-201 ◽

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

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Functional MRI detects perfusion impairment in renal allografts with delayed graft function

AJP Renal Physiology ◽

10.1152/ajprenal.00064.2015 ◽

2015 ◽

Vol 308 (12) ◽

pp. F1444-F1451 ◽

Cited By ~ 26

Author(s):

Katja Hueper ◽

Faikah Gueler ◽

Jan Hinrich Bräsen ◽

Marcel Gutberlet ◽

Mi-Sun Jang ◽

...

Keyword(s):

Renal Function ◽

Kidney Transplantation ◽

Functional Mri ◽

Graft Loss ◽

Graft Function ◽

Resistance Index ◽

Deceased Donor ◽

Renal Perfusion ◽

Delayed Graft Function ◽

Renal Outcome

Delayed graft function (DGF) after kidney transplantation is not uncommon, and it is associated with long-term allograft impairment. Our aim was to compare renal perfusion changes measured with noninvasive functional MRI in patients early after kidney transplantation to renal function and allograft histology in biopsy samples. Forty-six patients underwent MRI 4–11 days after transplantation. Contrast-free MRI renal perfusion images were acquired using an arterial spin labeling technique. Renal function was assessed by estimated glomerular filtration rate (eGFR), and renal biopsies were performed when indicated within 5 days of MRI. Twenty-six of 46 patients had DGF. Of these, nine patients had acute rejection (including borderline), and eight had other changes (e.g., tubular injury or glomerulosclerosis). Renal perfusion was significantly lower in the DGF group compared with the group with good allograft function (231 ± 15 vs. 331 ± 15 ml·min−1·100 g−1, P < 0.001). Living donor allografts exhibited significantly higher perfusion values compared with deceased donor allografts ( P < 0.001). Renal perfusion significantly correlated with eGFR ( r = 0.64, P < 0.001), resistance index ( r = −0.57, P < 0.001), and cold ischemia time ( r = −0.48, P < 0.01). Furthermore, renal perfusion impairment early after transplantation predicted inferior renal outcome and graft loss. In conclusion, noninvasive functional MRI detects renal perfusion impairment early after kidney transplantation in patients with DGF.

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Synergistic impact of pre-sensitization and delayed graft function on allograft rejection in deceased donor kidney transplantation

Scientific Reports ◽

10.1038/s41598-021-95327-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hanbi Lee ◽

Yohan Park ◽

Tae Hyun Ban ◽

Sang Heon Song ◽

Seung Hwan Song ◽

...

Keyword(s):

Kidney Transplantation ◽

Allograft Rejection ◽

Patient Survival ◽

Graft Function ◽

Deceased Donor ◽

Donor Kidney ◽

Deceased Donor Kidney ◽

Allograft Function ◽

Donor Kidney Transplantation ◽

Deceased Donor Kidney Transplantation

AbstractThe aim of this study is to investigate whether or not delayed graft function (DGF) and pre-transplant sensitization have synergistic adverse effects on allograft outcome after deceased donor kidney transplantation (DDKT) using the Korean Organ Transplantation Registry (KOTRY) database, the nationwide prospective cohort. The study included 1359 cases between May 2014 and June 2019. The cases were divided into 4 subgroups according to pre-sensitization and the development of DGF post-transplant [non-pre-sensitized-DGF(−) (n = 1097), non-pre-sensitized-DGF(+) (n = 127), pre-sensitized-DGF(−) (n = 116), and pre-sensitized-DGF(+) (n = 19)]. We compared the incidence of biopsy-proven allograft rejection (BPAR), time-related change in allograft function, allograft or patient survival, and post-transplant complications across 4 subgroups. The incidence of acute antibody-mediated rejection (ABMR) was significantly higher in the pre-sensitized-DGF(+) subgroup than in other 3 subgroups. In addition, multivariable cox regression analysis demonstrated that pre-sensitization combined with DGF is an independent risk factor for the development of acute ABMR (hazard ratio 4.855, 95% confidence interval 1.499–15.727). Moreover, DGF and pre-sensitization showed significant interaction (p-value for interaction = 0.008). Pre-sensitization combined with DGF did not show significant impact on allograft function, and allograft or patient survival. In conclusion, the combination of pre-sensitization and DGF showed significant synergistic interaction on the development of allograft rejection after DDKT.

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Combined Impact of Pre-sensitization and Delayed Graft Function on Allograft Rejection in Deceased Donor Kidney Transplantation: Nationwide Cohort Study

10.21203/rs.3.rs-227446/v1 ◽

2021 ◽

Author(s):

Hanbi Lee ◽

Yohan Park ◽

Tae Hyun Ban ◽

Sang Heon Song ◽

Seung Hwan Song ◽

...

Keyword(s):

Kidney Transplantation ◽

Allograft Rejection ◽

Patient Survival ◽

Graft Function ◽

Deceased Donor ◽

Donor Kidney ◽

Deceased Donor Kidney ◽

Allograft Function ◽

Donor Kidney Transplantation ◽

Deceased Donor Kidney Transplantation

Abstract The aim of this study is to investigate whether or not delayed graft function (DGF) and pre-transplant sensitization has a synergistic adverse effect on allograft outcome after deceased donor kidney transplantation (DDKT) using the Korean Organ Transplantation Registry (KOTRY) database, the nationwide prospective cohort. The study included 1,370 cases between May 2014 and June 2019. The cases were divided into 4 subgroups according to pre-sensitization and the development of DGF post-transplant (non-pre-sensitized-DGF(-)(n=1100), non-pre-sensitized-DGF(+)(n=133), pre-sensitized-DGF(-)(n=116), and pre-sensitized-DGF(+)(n=21)). We compared the incidence of biopsy-proven allograft rejection (BPAR), time-related change in allograft function, allograft or patient survival, and post-transplant complications across 4 subgroups. The incidence of overall BPAR and acute antibody-mediated rejection (ABMR) was significantly higher in the pre-sensitized-DGF(+) subgroup than in other 3 subgroups. In addition, multivariable cox regression analysis demonstrated that pre-sensitization combined with DGF is an independent risk factor for both overall BPAR (hazard ratio 3.253, p = 0.005) and acute ABMR (hazard ratio 7.589, p < 0.001). Moreover, DGF and pre-sensitization showed significant interaction. Pre-sensitization combined with DGF did not show significant impact on allograft function, and allograft or patient survival. In conclusion, pre-sensitization and DGF had a synergistic adverse impact on allograft rejection after DDKT.

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Degree of Glomerulosclerosis in Procurement Kidney Biopsies from Marginal Donor Kidneys and Their Implications in Predicting Graft Outcomes

Journal of Clinical Medicine ◽

10.3390/jcm9051469 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1469

Author(s):

Wisit Cheungpasitporn ◽

Charat Thongprayoon ◽

Pradeep K Vaitla ◽

Api Chewcharat ◽

Panupong Hansrivijit ◽

...

Keyword(s):

Acute Rejection ◽

Graft Survival ◽

Graft Failure ◽

Patient Survival ◽

Graft Function ◽

Deceased Donor ◽

Delayed Graft Function ◽

Organ Shortage ◽

Increased Risk ◽

Significant Difference

Background: This study aimed to assess the association between the percentage of glomerulosclerosis (GS) in procurement allograft biopsies from high-risk deceased donor and graft outcomes in kidney transplant recipients. Methods: The UNOS database was used to identify deceased-donor kidneys with a kidney donor profile index (KDPI) score > 85% from 2005 to 2014. Deceased donor kidneys were categorized based on the percentage of GS: 0–10%, 11–20%, >20% and no biopsy performed. The outcome included death-censored graft survival, patient survival, rate of delayed graft function, and 1-year acute rejection. Results: Of 22,006 kidneys, 91.2% were biopsied showing 0–10% GS (58.0%), 11–20% GS (13.5%), >20% GS (19.7%); 8.8% were not biopsied. The rate of kidney discard was 48.5%; 33.6% in 0–10% GS, 68.9% in 11–20% GS, and 77.4% in >20% GS. 49.8% of kidneys were discarded in those that were not biopsied. Death-censored graft survival at 5 years was 75.8% for 0–10% GS, 70.9% for >10% GS, and 74.8% for the no biopsy group. Among kidneys with >10% GS, there was no significant difference in death-censored graft survival between 11–20% GS and >20% GS. Recipients with >10% GS had an increased risk of graft failure (HR = 1.27, p < 0.001), compared with 0–10% GS. There was no significant difference in patient survival, acute rejection at 1-year, and delayed graft function between 0% and 10% GS and >10% GS. Conclusion: In >85% KDPI kidneys, our study suggested that discard rates increased with higher percentages of GS, and GS >10% is an independent prognostic factor for graft failure. Due to organ shortage, future studies are needed to identify strategies to use these marginal kidneys safely and improve outcomes.

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Pre-Transplant Weight Loss and Survival after Kidney Transplantation

American Journal of Nephrology ◽

10.1159/000437341 ◽

2015 ◽

Vol 41 (6) ◽

pp. 448-455 ◽

Cited By ~ 5

Author(s):

Edmund Huang ◽

Suphamai Bunnapradist

Keyword(s):

Weight Loss ◽

Graft Survival ◽

Transplant Patient ◽

Patient Survival ◽

Graft Loss ◽

Survival Status ◽

Patient Status ◽

Adult Status ◽

Patient And Graft Survival ◽

United Network

Background/Aims: We examined post-transplant survival among obese kidney candidates who were temporarily designated waitlist inactive (status 7) due to their weight. Methods: Using OPTN/United Network for Organ Sharing data, patient and graft survival of adult status 7 recipients with a registration body mass index (BMI) ≥30 kg/m2 (n = 328) were compared to all others (controls; n = 74,066). Status 7 recipients were then matched to controls to assess whether pre-transplant weight loss was associated with a survival benefit. Results: Median BMI at registration (38 vs. 27 kg/m2, p < 0.001) and transplant (36 vs. 27 kg/m2, p < 0.001) and reduction in BMI while waitlisted (-5.0 vs. 0.0%, p < 0.001) were higher among status 7 than controls. Patient (status 7: 87.3%; control: 89.3%; p = 0.90) and graft survival (status 7: 82.9%; control: 81.6%; p = 0.75) were similar over 4 years. There was no association between status 7 and mortality (HR 0.96, 95% CI 0.59-1.57) or graft loss (HR 0.95, 95% CI 0.66-1.38) in the overall population nor between matched status 7 recipients and controls (patient survival: 86.0 vs. 87.5%, p = 0.20; graft survival: 82.6 vs. 77.2%, p = 0.61). Conclusion: Among obese status 7 kidney candidates previously considered too obese for transplant, patient and graft survival were comparable to the general transplant population. No difference in survival was observed with pre-transplant weight loss.

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