scholarly journals The Sum of Kidney Donor Profile Index and Estimated Post-Transplant Survival Scale and Their Correlation with eGFR Decline in Deceased Donor Kidney Recipients

2021 ◽  
Author(s):  
Pablo Maggiani-Aguilera ◽  
Sergio Hernández-Estrada ◽  
José H. Cano-Cervantes ◽  
Jonathan S. Chávez-Iñiguez ◽  
Christian Pérez-Flores ◽  
...  
Keyword(s):  
Deceased Donor ◽  
Kidney Donor ◽  
Donor Kidney ◽  
Transplant Survival ◽  
Post Transplant ◽  
Kidney Recipients ◽  
Deceased Donor Kidney ◽  
Egfr Decline

scholarly journals Regional Disparities in Transplantation With Deceased Donor Kidneys With Kidney Donor Profile Index Less Than 20% Among Candidates With Top 20% Estimated Post Transplant Survival

2019 ◽  
Vol 29 (4) ◽  
pp. 354-360 ◽  
Author(s):  
S. Ali Husain ◽  
Kristen L. King ◽  
Geoffrey K. Dube ◽  
Demetra Tsapepas ◽  
David J. Cohen ◽  
...  
Keyword(s):  
United States ◽  
Research Question ◽  
Deceased Donor ◽  
The United States ◽  
Strongly Correlated ◽  
Kidney Donor ◽  
Donor Kidney ◽  
Transplant Survival ◽  
Post Transplant ◽  
Deceased Donor Kidney

Introduction: The Kidney Allocation System in the United States prioritizes candidates with Estimated Post-Transplant Survival (EPTS) ≤20% to receive deceased donor kidneys with Kidney Donor Profile Index (KDPI) ≤20%. Research Question: We compared access to KDPI ≤ 20% kidneys for EPTS ≤ 20% candidates across the United States to determine whether geographic disparities in access to these low KDPI kidneys exist. Design: We identified all incident adult deceased donor kidney candidates wait-listed January 1, 2015, to March 31, 2018, using United Network for Organ Sharing data. We calculated the proportion of candidates transplanted, final EPTS, and KDPI of transplanted kidneys for candidates listed with EPTS ≤ 20% versus >20%. We compared the odds of receiving a KDPI ≤ 20% deceased donor kidney for EPTS ≤ 20% candidates across regions using logistic regression. Results: Among 121 069 deceased donor kidney candidates, 28.5% had listing EPTS ≤ 20%. Of these, 16.1% received deceased donor kidney transplants (candidates listed EPTS > 20%: 17.1% transplanted) and 12.3% lost EPTS ≤ 20% status. Only 49.4% of transplanted EPTS ≤ 20% candidates received a KDPI ≤ 20% kidney, and 48.3% of KDPI ≤ 20% kidneys went to recipients with EPTS > 20% at the time of transplantation. Odds of receiving a KDPI ≤ 20% kidney were highest in region 6 and lowest in region 9 (odds ratio 0.19 [0.13 to 0.28]). The ratio of KDPI ≤ 20% donors per EPTS ≤ 20% candidate and likelihood of KDPI ≤ 20% transplantation were strongly correlated ( r 2 = 0.84). Discussion: Marked geographic variation in the likelihood of receiving a KDPI ≤ 20% deceased donor kidney among transplanted EPTS ≤ 20% candidates exists and is related to differences in organ availability within allocation borders. Policy changes to improve organ sharing are needed to improve equity in access to low KDPI kidneys.

scholarly journals Validation of a survival benefit estimator tool in a cohort of European kidney transplant recipients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Armando Coca ◽  
Carlos Arias-Cabrales ◽  
Ana Lucía Valencia ◽  
Carla Burballa ◽  
Juan Bustamante-Munguira ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Survival Benefit ◽  
Patient Survival ◽  
Deceased Donor ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Donor Kidney ◽  
Transplant Survival ◽  
Post Transplant ◽  
Deceased Donor Kidney

Abstract Pre-transplant prognostic scores help to optimize donor/recipient allocation and to minimize organ discard rates. Since most of these scores come from the US, direct application in non-US populations is not advisable. The Survival Benefit Estimator (SBE), built upon the Estimated Post-Transplant Survival (EPTS) and the Kidney Donor Profile Index (KDPI), has not been externally validated. We aimed to examine SBE in a cohort of Spanish kidney transplant recipients. We designed a retrospective cohort-based study of deceased-donor kidney transplants carried out in two different Spanish hospitals. Unadjusted and adjusted Cox models were applied for patient survival. Predictive models were compared using Harrell’s C statistics. SBE, EPTS and KDPI were independently associated with patient survival (p ≤ 0.01 in all models). Model discrimination measured with Harrell’s C statistics ranged from 0.57 (KDPI) to 0.69 (SBE) and 0.71 (EPTS). After adjustment, SBE presented similar calibration and discrimination power to that of EPTS. SBE tended to underestimate actual survival, mainly among high EPTS recipients/high KDPI donors. SBE performed acceptably well at discriminating post-transplant survival in a cohort of Spanish deceased-donor kidney transplant recipients, although its use as the main allocation guide, especially for high KDPI donors or high EPTS recipients requires further testing.

scholarly journals Urinary Biomarkers α-GST and π-GST for Evaluation and Monitoring in Living and Deceased Donor Kidney Grafts

2019 ◽  
Vol 8 (11) ◽  
pp. 1899 ◽  
Author(s):  
Shadi Katou ◽  
Brigitta Globke ◽  
M. Haluk Morgul ◽  
Thomas Vogel ◽  
Benjamin Struecker ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Function ◽  
Rejection Sensitivity ◽  
Deceased Donor ◽  
Urine Samples ◽  
Kidney Graft ◽  
Donor Kidney ◽  
Kidney Recipients ◽  
Deceased Donor Kidney ◽  
Brain Dead

The aim of this study was to analyze the value of urine α- and π-GST in monitoring and predicting kidney graft function following transplantation. In addition, urine samples from corresponding organ donors was analyzed and compared with graft function after organ donation from brain-dead and living donors. Urine samples from brain-dead (n = 30) and living related (n = 50) donors and their corresponding recipients were analyzed before and after kidney transplantation. Urine α- and π-GST values were measured. Kidney recipients were grouped into patients with acute graft rejection (AGR), calcineurin inhibitor toxicity (CNI), and delayed graft function (DGF), and compared to those with unimpaired graft function. Urinary π-GST revealed significant differences in deceased kidney donor recipients with episodes of AGR or DGF at day one after transplantation (p = 0.0023 and p = 0.036, respectively). High π-GST values at postoperative day 1 (cutoff: >21.4 ng/mg urine creatinine (uCrea) or >18.3 ng/mg uCrea for AGR or DGF, respectively) distinguished between rejection and no rejection (sensitivity, 100%; specificity, 66.6%) as well as between DGF and normal-functioning grafts (sensitivity, 100%; specificity, 62.6%). In living donor recipients, urine levels of α- and π-GST were about 10 times lower than in deceased donor recipients. In deceased donors with impaired graft function in corresponding recipients, urinary α- and π-GST were elevated. α-GST values >33.97 ng/mg uCrea were indicative of AGR with a sensitivity and specificity of 77.7% and 100%, respectively. In deceased donor kidney transplantation, evaluation of urinary α- and π-GST seems to predict different events that deteriorate graft function. To elucidate the potential advantages of such biomarkers, further analysis is warranted.

scholarly journals Response to Bui et al, “Patient Functional Status at Transplant and Its Impact on Posttransplant Survival of Adult Deceased–donor Kidney Recipients”

2020 ◽  
Vol 104 (2) ◽  
pp. e59 ◽  
Author(s):  
Bertram L. Kasiske ◽  
Nicholas Salkowski ◽  
Andrew Wey ◽  
David Zaun ◽  
Ajay K. Israni ◽  
...  
Keyword(s):  
Functional Status ◽  
Deceased Donor ◽  
Donor Kidney ◽  
Kidney Recipients ◽  
Deceased Donor Kidney

scholarly journals Validating Early Post–Transplant Outcomes Reported for Recipients of Deceased Donor Kidney Transplants

2015 ◽  
Vol 11 (2) ◽  
pp. 324-331 ◽  
Author(s):  
Vishnu S. Potluri ◽  
Chirag R. Parikh ◽  
Isaac E. Hall ◽  
Joseph Ficek ◽  
Mona D. Doshi ◽  
...  
Keyword(s):  
Deceased Donor ◽  
Kidney Transplants ◽  
Donor Kidney ◽  
Post Transplant ◽  
Transplant Outcomes ◽  
Deceased Donor Kidney

External validation of the US and UK kidney donor risk indices for deceased donor kidney transplant survival in the Australian and New Zealand population

2019 ◽  
Vol 34 (12) ◽  
pp. 2127-2131 ◽  
Author(s):  
Philip A Clayton ◽  
Kathryn Dansie ◽  
Matthew P Sypek ◽  
Sarah White ◽  
Steve Chadban ◽  
...  
Keyword(s):  
New Zealand ◽  
Graft Survival ◽  
Risk Index ◽  
External Validation ◽  
Deceased Donor ◽  
Kidney Donor ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
The Us ◽  
The Uk

Abstract Background The US Kidney Donor Risk Index (KDRI) and the UK KDRI were developed to estimate the risk of graft failure following kidney transplantation. Neither score has been validated in the Australian and New Zealand (ANZ) population. Methods Using data from the Australia and New Zealand Organ Donor (ANZOD) and Dialysis and Transplant (ANZDATA) Registries, we included all adult deceased donor kidney-only transplants performed in ANZ from 2005 to 2016 (n = 6405). The KDRI was calculated using both the US donor-only and UK formulae. Three Cox models were constructed (Model 1: KDRI only; Model 2: Model 1 + transplant characteristics; Model 3: Model 2 + recipient characteristics) and compared using Harrell’s C-statistics for the outcomes of death-censored graft survival and overall graft survival. Results Both scores were strongly associated with death-censored and overall graft survival (P < 0.0001 in all models). In the KDRI-only models, discrimination of death-censored graft survival was moderately good with C-statistics of 0.63 and 0.59 for the US and UK scores, respectively. Adjusting for transplant characteristics resulted in marginal improvements of the US KDRI to 0.65 and the UK KDRI to 0.63. The addition of recipient characteristics again resulted in marginal improvements of the US KDRI to 0.70 and the UK KDRI to 0.68. Similar trends were seen for the discrimination of overall graft survival. Conclusions The US and UK KDRI scores were moderately good at discriminating death-censored and overall graft survival in the ANZ population, with the US score performing slightly better in all models.

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