Prognostic factors affecting graft and patient survival in cadaveric and living kidney transplantation

The relationship of donor source and age on short- and long-term allograft survival in pediatric renal transplantation

Limited pediatric data on allograft survival from advanced aged kidney donors exist. To determine the influence of donor source and age on allograft survival in pediatric renal transplant recipients, we analyzed the OPTN database. Allograft survival for 7291 pediatric renal transplants was evaluated. Up to five yr post-transplantation, graft survival was higher for LD vs. DD recipients. At seven yr, allograft survival was 71% in 18-54 yr-old LD recipients, 59.1% in >or=55 yr-old LD, and 45.1% in >or=50 yr-old DD recipients. An approximate 35% improvement in allograft survival in 18-54 yr-old LD recipients was observed. Multivariate results showed that recipients of LD 35-49 (aRR 0.66, 95% CI 0.55-0.80) and LD 50-54 (aRR 0.65, 95% CI 0.45-0.94) have a graft survival advantage over the ideal DD. In LD >or=55 yr, no improvement in graft survival was observed when compared with the 18-34 yr-old DD. In summary, we observed in a pediatric population, <55 yr-old LD kidneys afford improved long-term allograft survival when compared with DD kidney recipients. Increasing awareness of the long-term graft survival advantage for children receiving an LD kidney, even from older donors, should be a priority.

Deceased donor renal transplantation--does side matter?

BACKGROUND

The aim of the present study was to determine whether the deceased donor kidney side (left or right kidney) was predictive of subsequent kidney transplant outcomes.

METHODS

A retrospective analysis was undertaken of the left-right deceased donor kidney pairs transplanted into recipients with end-stage renal failure in Queensland between 1 April 1994 and 31 March 2004.

RESULTS

A total of 201 left-right deceased donor kidney pairs were transplanted into 402 patients. The baseline characteristics of the recipients in the two groups were comparable, except that the patients receiving right kidneys had lower body mass indices and shorter cold ischaemic times. No differences were seen between the left and right kidney recipient groups with respect to operative duration (3.02 +/- 0.67 vs 3.12 +/- 0.72 h, P = 0.16), warm ischaemic time (0.62 +/- 0.18 vs 0.65 +/- 0.21, P = 0.09), delayed graft function (4 vs 6%, respectively, P = 0.26) or a composite vascular, haemorrhagic, ureteric and infective post-operative complication end-point (22 vs 22%, P = 0.90). Estimated glomerular filtration rates were almost identical at 1 month (52.7 +/- 39.6 vs 51.0 +/- 24.0 ml/min/1.73 m(2), P = 0.34) and remained comparable thereafter. Respective death-censored graft survival rates for left and right kidney recipients were 100 and 100% at 1 year, 99.4 and 96.4% at 3 years and 96.3 and 95.5% at 5 years, respectively (P = 0.67).

CONCLUSIONS

Although left and right deceased donor kidneys present different operative challenges, the present results suggest that the probability of early post-operative complications, delayed graft function, impaired early and medium-term renal allograft function or death-censored graft failure is comparable between left and right kidney recipients.

Preoperative evaluation of living kidney donors using multirow detector computed tomography: comparison with digital subtraction angiography and intraoperative findings

To assess the accuracy of multirow detector computed tomography (MDCT) for the evaluation of renal anatomy for preoperative donor assessment in living related kidney transplantation. MDCT-scans (4- and 16-slice-CT) of 51 consecutive living kidney donors (age, 51.6 +/- 9.7 years; range, 28-68 years) were analysed by three blinded observers and compared with digital subtraction angiography (DSA) and surgery. Contrast-enhanced MDCT was performed with 1 mm slice thickness reconstruction interval during arterial and venous phases. Supernumerary renal arteries, veins, early branching of vessels and abnormalities of the ureters were documented. The overall accuracy of computed tomography angiography (CTA) for detection and classification of surgically relevant arterial variants was 97% (99/102). The interpretation of 16-channel MDCT images was correct in all cases (accuracy, 100%), while the four-channel CTA had three incorrect results regarding the differentiation of early branching vessels from double renal arteries (accuracy, 93%). The overall accuracy of DSA was 91%. Renal vein abnormalities were correctly diagnosed with MDCT in 100% compared with 89% correct findings with DSA. There were three kidneys with incomplete ureter duplication, detected both with MDCT and DSA. MDCT demonstrated superior accuracy compared with non-selective DSA for the preoperative assessment of renal anatomy in living kidney donors; and for the distinction of supernumerary arteries versus early branching patterns, 16-channel CTA data were better than those of the four-channel system.

Living Donor Renal Transplantation: Prognostic Factors on Graft Survival

INTRODUCTION

Living donor renal transplantation is a treatment option for patients on dialysis in view of the ever-growing transplantation waiting lists and the stagnation in the number of deceased donors.

OBJECTIVES

The objectives of this study were to provide retrospective review of our living donor kidney transplantation series (1978-2003) and analysis of graft survival prognostic factors.

MATERIALS AND METHODS

Among 121 living donor transplantations, the donor mean age was 50.9 years (SD, 1.53) and recipient mean age was 30.4 years (SD, 1.4). Eighty-eight percent of donors were women, 90% were related: siblings 21%, parents 69%, and spouses 6.6%. Kidney failure was of nephrological etiology in 65% of patients and urologic in 15.6%. Eighty-four percent were primary grafts and 16% were second ones. Also, 66.7% of kidneys were placed in the iliac fossa and the rest were left orthotopic approaches. Other analyzed variables included donor gender, acute rejection episodes (ARE), creatinine levels at 1 and 6 months, hypertension (HT), and pediatric recipients.

RESULTS

Univariate analysis (Kaplan-Meier) showed that, in patients suffering from ARE or not, the mean graft survival was 7.5 and 15 years, respectively (P <.05). Mean graft survival among patients with nephrological problems was 8 years and in those with urologic etiology 15 years (P < .05). Multivariate analysis with Cox regression showed that etiology, ARE, and creatinine level at 6 months after transplantation were independent prognostic variables for graft failure. The overall graft survival rates were 78% at 5 years, 58% at 10 years, 42% at 15 years, and 24% at 20 years follow-up.

CONCLUSION

Living donor kidney transplantation is a valid treatment choice for end-stage patients with excellent graft survival rates, especially in cases of urologic etiology. Development of new immunosupressant strategies will help improve outcomes.