scholarly journals Suitability for Kidney Transplantation in AL Amyloidosis: A Survey Study of Transplant and Amyloidosis Physicians

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0004232021
Author(s):  
Robert Lam ◽  
Mary Ann Lim ◽  
Laura M. Dember
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Kidney Failure ◽  
The United States ◽  
Survey Study ◽  
Al Amyloidosis ◽  
Term Survival ◽  
Transplant Program ◽  
Academic Medical ◽  
Degree Of Confidence

Background: Historically, kidney transplantation has been considered inappropriate for most patients with AL amyloidosis-associated kidney failure because of concerns about recurrent disease in the allograft and poor long-term survival. With improvements in rates and durability of hematologic responses and survival that have accompanied treatment advances, a greater proportion of patients with AL amyloidosis may be suitable for kidney transplantation. However, there are no widely accepted criteria for kidney transplant eligibility for this patient population. Methods: We administered surveys electronically to transplant nephrologists and amyloidosis experts at a geographically diverse set of academic medical centers in the United States. Questions were designed to elucidate views about suitability and timing of kidney transplantation for patients with AL amyloidosis-associated kidney failure. Results: The survey was completed by 20 (65%) of invited amyloidosis experts and 20 (29%) of invited transplant physicians. Respondents indicated that, for patients with AL amyloidosis, most transplant nephrologists have limited experience with both determining eligibility for and providing care after kidney transplantation. Most transplant nephrologists and amyloidosis experts viewed anticipated patient survival as the most important determinant of suitability for kidney transplantation. Compared with transplant program respondents, amyloidosis program respondents reported a higher degree of confidence in determining suitability for kidney transplantation, were comfortable proceeding with kidney transplantation earlier after patients attained a hematologic response, and, were less concerned about extra-renal amyloid involvement as a barrier to kidney transplantation. In both groups, most respondents indicated that there is a lack of consensus between amyloidosis and kidney transplant physicians about criteria for determining suitability for kidney transplantation. Conclusion: Views about criteria for kidney transplantation for patients with AL amyloidosis-associated kidney failure differed between amyloidosis and transplant nephrology program respondents, with amyloidosis specialists generally favoring a less restrictive approach to transplant eligibility. The findings suggest a need for consensus building across specialties.

scholarly journals Sex Disparity in Deceased-Donor Kidney Transplant Access by Cause of Kidney Disease

2021 ◽  
Vol 16 (2) ◽  
pp. 241-250
Author(s):  
Patrick Ahearn ◽  
Kirsten L. Johansen ◽  
Jane C. Tan ◽  
Charles E. McCulloch ◽  
Barbara A. Grimes ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Kidney Transplant ◽  
Kidney Failure ◽  
Deceased Donor ◽  
The United States ◽  
Hazard Ratio ◽  
Donor Kidney ◽  
Deceased Donor Kidney

Background and objectivesWomen with kidney failure have lower access to kidney transplantation compared with men, but the magnitude of this disparity may not be uniform across all kidney diseases. We hypothesized that the attributed cause of kidney failure may modify the magnitude of the disparities in transplant access by sex.Design, setting, participants, & measurementsWe performed a retrospective cohort study of adults who developed kidney failure between 2005 and 2017 according to the United States Renal Data System. We used adjusted Cox models to examine the association between sex and either access to waitlist registration or deceased-donor kidney transplantation, and tested for interaction between sex and the attributed cause of kidney failure using adjusted models.ResultsAmong a total of 1,478,037 patients, 271,111 were registered on the waitlist and 89,574 underwent deceased-donor transplantation. The rate of waitlisting was 6.5 per 100 person-years in women and 8.3 per 100 person-years for men. In adjusted analysis, women had lower access to the waitlist (hazard ratio, 0.89; 95% confidence interval, 0.89 to 0.90) and to deceased-donor transplantation after waitlisting (hazard ratio, 0.96; 95% confidence interval, 0.94 to 0.98). However, there was an interaction between sex and attributed cause of kidney disease in adjusted models (P<0.001). Women with kidney failure due to type 2 diabetes had 27% lower access to the kidney transplant waitlist (hazard ratio, 0.73; 95% confidence interval, 0.72 to 0.74) and 11% lower access to deceased-donor transplantation after waitlisting compared with men (hazard ratio, 0.89; 95% confidence interval, 0.86 to 0.92). In contrast, sex disparities in access to either the waitlist or transplantation were not observed in kidney failure secondary to cystic disease.ConclusionsThe disparity in transplant access by sex is not consistent across all causes of kidney failure. Lower deceased-donor transplantation rates in women compared with men are especially notable among patients with kidney failure attributed to diabetes.

scholarly journals Employment of Patients With Kidney Failure Treated With Dialysis or Kidney Transplantation - A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Lilli Kirkeskov ◽  
Rasmus Carlsen ◽  
Thomas Lund ◽  
Niels-Henrik Buus
Keyword(s):  
Systematic Review ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Kidney Failure ◽  
Educational Level ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Employment Rate ◽  
Dialysis Patients ◽  
Post Transplant

Abstract Background: Patients with kidney failure treated with dialysis or kidney transplantation experience difficulties maintaining employ­­ment due to the condition itself as well as the treatment. We aimed to establish the rate of employment before and after initiation of dialysis and after kidney transplantation and to identify predictors of employment during dialysis and post-transplant.Methods: This systematic review and meta-analysis was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA, for studies that included employment rate in adults receiving dialysis or a kidney transplant. The literature search included cross sectional or cohort studies published in English in the period from January 1966 to August 2020 in the databases PubMed, Embase, and Cochrane Library. Data of employment rate, study population, age, gender, educational level, dialysis duration, kidney donor, ethnicity, dialysis modality, waiting time for transplantation, diabetes, and depression were extracted. Quality assessment was performed using the Newcastle-Ottawa Scale. Meta-analysis for predictors for employment and odds ratio; confidence intervals; and test for heterogeneity were calculated using Chi-squared statistics and I2. PROSPERO registration number: CRD42020188853.Results. 33 studies with 162,059 participants during dialysis and 31 studies with 137,742 participants receiving kidney transplantation. Dialysis patients were on average 52.6 years old (range 16-79), 60.3% males and kidney transplant patients 46.7 years old (range 18-78), 59.8% males. The employment rate (weighted mean) for dialysis patients was 26.3% (range 10.5-59.7%); pre-transplant 36.9% (range 25-86%), and post-transplant 38.2% (range 14.2-85%). Predictors for employment during dialysis and post-transplant were male, non-diabetic, peritoneal dialysis, and higher educational level, and post-transplant: pre-transplant employment, younger age, transplantation with a living donor kidney, and without depression.Conclusions: Patients with kidney failure had a low employment rate during dialysis, pre- and post-transplant. Kidney failure patients should be supported through a combination of clinical and social measures to ensure they remain in work.

Machine learning support for decision making in kidney transplantation: step-by-step development of a technological solution (Preprint)

2021 ◽  
Author(s):  
François-Xavier Paquette ◽  
Amir Ghassemi ◽  
Olga Bukhtiyarova ◽  
Moustapha Cisse ◽  
Natanael Gagnon ◽  
...  
Keyword(s):  
Neural Networks ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Graft Survival ◽  
The United States ◽  
Technological Solution ◽  
Discriminative Ability ◽  
Potential Donor ◽  
Transplant Survival ◽  
Transplant Outcomes

BACKGROUND Kidney transplantation is the preferred treatment option for patients with end-stage renal disease. To maximize patient and graft survival, the allocation of donor organs to potential recipients requires careful consideration. OBJECTIVE To develop an innovative technological solution to enable better prediction of kidney transplant survival for each potential donor-recipient pair. METHODS We used de-identified data on past organ donors, recipients and transplant outcomes in the United States from the Scientific Registry of Transplant Recipients (SRTR). To predict transplant outcomes for potential donor-recipient pairs, we used several survival analysis models, including regression analysis (Cox Proportional Hazards), Random Survival Forests (RSF) and several artificial neural networks (DeepSurv, DeepHit, Recurrent Neural Networks (RNN)). We evaluated the performance of each model on their ability to predict the probability of graft survival after kidney transplantation from deceased donors. Three metrics were employed: the C-index, the Integrated Brier Score and the Integrated Calibration Index (ICI), along with calibration plots. RESULTS Based on the C-index metrics, the neural network-based models (DeepSurv, DeepHit, RNN) had better discriminative ability than the Cox model and RSF (0.650, 0.661, 0.659 vs 0.646 and 0.644, correspondingly). The proposed RNN model offered a compromise between the good discriminative ability and calibration and was implemented in a technological solution of TRL-4. CONCLUSIONS Our technological solution based on RNN model can effectively predict kidney transplant survival and provide support for medical professionals and candidate recipients in determining the most optimal donor-recipient pair. CLINICALTRIAL Not applicable.

MANAGEMENT OF HYPERPARATHYROIDISM IN KIDNEY TRANSPLANTATION CANDIDATES: A NEED FOR CONSENSUS

2020 ◽  
Vol 26 (3) ◽  
pp. 299-304 ◽  
Author(s):  
Hubert Golingan ◽  
Shenae K. Samuels ◽  
Pauline Camacho ◽  
Darshana M. Dadhania ◽  
Fernando E. Pedraza-Taborda ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Transplantation ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Kidney Transplant ◽  
American Association ◽  
The United States ◽  
Standards Of Care ◽  
Endocrine Surgery ◽  
Transplant Candidates

Objective: To assess the evolving standards of care for hyperparathyroidism in kidney transplant candidates. Methods: An 11-question, Institutional Review Board–approved survey was designed and reviewed by multiple institutions. The questionnaire was made available to the American Society of Transplantation's Kidney Pancreas Community of Practice membership via their online hub from April through July 2019. Results: Twenty percent (n = 41) of kidney transplant centers responded out of 202 programs in the United States. Forty-one percent (n = 17) of respondents believed medical literature supports the concept that a serum parathyroid hormone level greater than 800 pg/mL could endanger the survival of a transplanted kidney and therefore makes transplantation in an affected patient relatively or absolutely contraindicated. Sixty-six percent (n = 27) said they occasionally recommend parathyroidectomy for secondary hyperparathyroidism prior to transplantation, and 66% (n = 27) recommend parathyroidectomy after transplantation based on persistent, unsatisfactory posttransplantation parathyroid hormone levels. Forty-six percent (n = 19) prefer subtotal parathyroidectomy as their choice; 44% (n = 18) had no standard preference. Endocrine surgery and otolaryngology were the most common surgical specialties consulted to perform parathyroidectomy in kidney transplant candidates. The majority of respondents (71%, n = 29) do not involve endocrinologists in the management of kidney transplantation candidates. Conclusion: Our survey shows wide divergence of clinical practice in the area of surgical management of kidney transplantation candidates with hyperparathyroidism. We suggest that medical/surgical societies involved in the transplantation care spectrum convene a multidisciplinary group of experts to create a new section in the kidney transplantation guidelines addressing the collaborative management of parathyroid disease in transplantation candidates. Abbreviations: AACE = American Association of Clinical Endocrinologists; AAES = American Association of Endocrine Surgeons; AHNS = American Head and Neck Society; CKD = chronic kidney disease; CKD-MBD = chronic kidney disease–mineral and bone disorder; ESRD = end-stage renal disease; HPT = hyperparathyroidism; KDIGO = Kidney Disease Improving Global Outcomes; KT = kidney transplantation; KTC = kidney transplant candidate; PTH = parathyroid hormone; PTX = parathyroidectomy; US = ultrasonography

Kidney transplant in multiple myeloma, the challenges, and potentials

2020 ◽  
Vol 4 (1-2) ◽  
pp. 15-17
Author(s):  
Nelson Leung
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Kidney Failure ◽  
Residual Disease ◽  
Graft Loss ◽  
Disease Assessment ◽  
Improve Patient Selection ◽  
Pros And Cons

Kidney failure is a common sequela of multiple myeloma. Tremendous progress in this disease over the past two decades has resulted in more than doubling of the median survival. Despite that, patients with irreversible kidney failure still have inferior outcomes as compared to those with intact kidney function. Kidney transplantation in these patients remains controversial. In this issue of Journal of Onco-Nephrology, two groups of clinicians caring for these patients debate the pros and cons of kidney transplantation in this population. The improvement of overall survival to 7.7 years in patients under the age of 65 years is a strong arg for kidney transplantation. In addition, the use of fluorescent in situ hybridization in risk assessment and minimal residual disease assessment for hematologic response could substantially improve patient selection for kidney transplantation. On the other hand, myeloma remains incurable and kidney failure itself is a high-risk feature. Despite advances, kidney transplantation in myeloma patients continues to present challenges with multiple myeloma relapse, rejection, and infection resulting in higher number of graft loss and death. Whether kidney transplant should be performed in patients with multiple myeloma currently remains debatable, but it may not be long before overall survival and disease control improve to the point where withholding kidney transplantation would be unethical. The questions in preparation for that day are should myeloma patients be held to the same metrics as patients without myeloma and if no, then what would be an acceptable overall and graft survival? Once the answers have been agreed upon by the experts and the governing bodies for transplantation, then proper clinical trials can be designed so that benefits can be optimized and precious resources not be wasted.

scholarly journals 50-year history of kidney transplantation in Hungary

2013 ◽  
Vol 154 (22) ◽  
pp. 846-849 ◽  
Author(s):  
Edit Szederkényi ◽  
Pál Szenohradszky ◽  
Ernő Csajbók ◽  
Ferenc Perner ◽  
László Asztalos ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Graft Rejection ◽  
Full Membership ◽  
Ministry Of Health ◽  
The Past ◽  
Transplant Program ◽  
History Of ◽  
Patient Groups ◽  
Special Patient

The first Hungarian kidney transplantation was performed by András Németh in Szeged in 1962, approximately 50 years ago. A preliminary agreement with Eurotransplant was signed in 2011, and special patient groups gained benefit from this cooperation in 2012, wnich lead to a full membership to Eurotransplant. This event inspired the authors to review the history of Hungarian kidney transplantation of the past 50 years, from the first operation to recent via the specific cornerstones of the transplant program. The donor of the first Hungarian kidney transplantation was the brother of the recipient. The operation itself was technically successful, but the lack of immunosuppression caused graft rejection, and the patient died after 79 days. His brother, the donor, is still healthy, after 50 years, and he encourages everybody to donate organs. Organized kidney transplant program started more than 10 years later, such as 1973, in Budapest. The program was supported by the Ministry of Health. New centers joined the program later, Szeged in 1979, Debrecen in 1991 and Pécs in 1993. These four transplant centers work currently in Hungary, and 6611 kidney transplantation has been performed up to the end of year 2012. Orv. Hetil., 2013, 154, 846–849.

496 Effectiveness of our living donor kidney transplant program. evaluation of discarded living donor in kidney transplantation

2013 ◽  
Vol 12 (1) ◽  
pp. e496
Author(s):  
Felip M. Musquera ◽  
I. Revuelta ◽  
L. Peri ◽  
F. Diekmann ◽  
A. Sanchez-Escudero ◽  
...  
Keyword(s):  
Program Evaluation ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Living Donor ◽  
Donor Kidney ◽  
Transplant Program ◽  
Living Donor Kidney Transplant ◽  
Living Donor Kidney

scholarly journals Factors Affecting the Long-Term Survival of Kidney Transplanta-tion in Northeastern of Iran between 2000 and 2015

2021 ◽  
Author(s):  
Rasoul Alimi ◽  
Maryam Hami ◽  
Monavar Afzalaghaee ◽  
Fatemeh Nazemian ◽  
Mahmood Mahmoodi ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Survival Rate ◽  
Kidney Transplant ◽  
Cox Regression ◽  
Historical Cohort ◽  
Term Survival ◽  
Long Term Survival ◽  
Effective Factors ◽  
Transplant Survival

Background: Graft and patient survival are of great importance after transplantation. This study aimed to determine the long-term survival rate of kidney transplantation and its effective factors among transplanted patients in Mashhad transplantation centers in northeastern Iran. Methods: Overall, 618 kidney transplant recipients were examined in different transplantation centers during the years from 2000 to 2015 in a historical cohort study. The Kaplan-Meier method and the Log-rank test were used to calculate the survival rate of the kidney transplant, and to check the difference between survival curves respectively. Modeling of effective factors in survival rate was performed using Cox regression model. Results: Overall, 1, 3, 5, 7, 10, and 15-year survival rate of kidney transplantation were 99%, 98%, 97%, 93%, 88 and 70% respectively. The adjusted hazard ratio indicated that variables such as recipient age >40 yr [HR=0.22, 95% CI=(0.071,0.691)], serum creatinine after transplantation >1.6 Mg/dl [HR=3.03, 95% CI=(1.284,7.125)], history of hypertension [HR=6.70, 95% CI=(2.746,16.348)], and BMI [HR (normal weight versus underweight)=0.26, 95% CI=(0.088,0.761), HR (over weight versus underweight)=0.13,95% CI=(0.038,0.442)] were significant factors on kidney transplant survival rate. Conclusion: The short-term transplant survival rate was good in transplant patients. What's more, through a consideration of variables such as age, creatinine serum after transplantation, history hypertension and body mass index, as well as proper planning to control their effect, it is possible to improve the long-term graft survival rate.

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