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Chavent B, Maillard N, Boutet C, Albertini JN, Duprey A, Favre JP. Prognostic Value of Aortoiliac Calcification Score in Kidney Transplantation Recipients. Ann Vasc Surg 2017; 44:245-252. [PMID: 28479451 DOI: 10.1016/j.avsg.2017.03.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/26/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Kidney recipients are increasingly older with arterial disease and extended arterial calcifications. In a kidney transplantation population, the prognosis value of aortic and iliac calcifications remains poorly explored. We aimed to assess the impact of pretransplantation aortoiliac vascular calcifications on patients, grafts survival, and cardiovascular events. METHODS This retrospective study included kidney transplantation patients from 2006 to 2012 for whom we had available presurgery abdominal computed tomography results (n = 100). We designed a score to quantify aortoiliac calcifications. Primary end points were patient and graft survival. Secondary end points were renal function and cardiovascular morbidity. Predictive performances of calcification score were assessed using area under receiver-operating characteristic curves. Patients were classified in quartiles depending on global calcium score value. RESULTS The cumulated rate of death and graft loss was 13% with no significant differences for survival between quartiles. No significant difference was observed in renal function (P = 0.4). Seventeen cardiovascular events were registered with a significant correlation between calcium score elevation and need of cardiovascular surgery during the follow-up (P = 0.01). Global calcium score had a predictive value of 74.5% (95% confidence interval 0.62-0.87) with 71% sensitivity and 73% specificity. CONCLUSIONS Aortoiliac calcifications do not decrease patient and graft survival. High calcium score predict cardiovascular events and procedures during the follow-up.
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Affiliation(s)
- Bertrand Chavent
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France.
| | - Nicolas Maillard
- Department of Nephrology and Kidney Transplantation, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Claire Boutet
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Noël Albertini
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Ambroise Duprey
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Pierre Favre
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
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Factors influencing renal graft survival: 7-Year experience of a single center. Medicina (B Aires) 2017; 53:224-232. [DOI: 10.1016/j.medici.2017.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 06/29/2017] [Accepted: 07/17/2017] [Indexed: 11/22/2022] Open
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Beyer B, Mandel P, Michl U, Pompe RS, Veleva V, Steuber T, Huland H, Graefen M, Tilki D. Oncological, functional and perioperative outcomes in transplant patients after radical prostatectomy. World J Urol 2016; 34:1101-5. [DOI: 10.1007/s00345-015-1758-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022] Open
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Al-Shraideh Y, Farooq U, Farney AC, Palanisamy A, Rogers J, Orlando G, Buckley MR, Reeves-Daniel A, Doares W, Kaczmorski S, Gautreaux MD, Iskandar SS, Hairston G, Brim E, Mangus M, Stratta RJ. Influence of recipient age on deceased donor kidney transplant outcomes in the expanded criteria donor era. Clin Transplant 2014; 28:1372-1382. [DOI: 10.1111/ctr.12463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Yousef Al-Shraideh
- Department of General Surgery; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Umar Farooq
- Department of General Surgery; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Alan C. Farney
- Department of General Surgery; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Amudha Palanisamy
- Department of Internal Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Jeffrey Rogers
- Department of General Surgery; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Giuseppe Orlando
- Department of General Surgery; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Michael R. Buckley
- Department of General Surgery; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Amber Reeves-Daniel
- Department of Internal Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
| | - William Doares
- Department of Pharmacy; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Scott Kaczmorski
- Department of Pharmacy; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Michael D. Gautreaux
- Department of General Surgery; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Samy S. Iskandar
- Department of Pathology; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Gloria Hairston
- Department of General Surgery; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Elizabeth Brim
- Department of General Surgery; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Margaret Mangus
- Department of General Surgery; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Robert J. Stratta
- Department of General Surgery; Wake Forest School of Medicine; Winston-Salem NC USA
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Impedovo SV, Ditonno P, Ricapito V, Bettocchi C, Gesualdo L, Grandaliano G, Selvaggi FP, Battaglia M. Advanced age is not an exclusion criterion for kidney transplantation. Transplant Proc 2014; 45:2650-3. [PMID: 24034014 DOI: 10.1016/j.transproceed.2013.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Renal transplantation in patients older than 60 years has long been regarded with skepticism owing to the increased risk of complications although, as compared with dialysis treatment, a graft seems to improve not only the quality of life but also long-term patient survival. This study sought to analyze the impact of recipient age older than 60 years on patient and graft outcomes. MATERIALS AND METHODS We retrospectively investigated the outcomes of 761 kidney transplant recipients from cadaveric donors performed between February 1998 and July 2011. While 69 subjects were at least 60 years of age (group A), 692 were younger than 60 years (group B) at the time of transplantation. RESULT Mean follow-up was 60.1 ± 38.5 months. Delayed graft function (DGF) requiring dialysis was observed in 36 group A (52.1%) and 205 group B (29.6%) subjects (P = .001). However, there were also significant differences between group A and group B in terms of mean donor age (60.3 vs 44.6 years; P < .001) and mean donor estimated creatinine clearance (57.8 vs 83.4 mL/min; P < .001). There were no significant differences in death-censored graft survival between the two groups, but elderly patients experienced worse survival (P = .0005). The most common causes of patient death were myocardial infarction, other cardiovascular complications, and tumors. CONCLUSION Kidney transplantation is a good option for elderly recipients with end-stage renal disease, providing long graft survival and a good quality of life, although these patients are more likely to develop cancer or cardiovascular disease. Our findings suggested that older patients should not be excluded a priori from transplantation, but meticulous screening for cancer and heart disease should be always be performed to improve outcomes.
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Affiliation(s)
- S V Impedovo
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
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Li LF, Shi KQ, Lin YQ, Wang LR, He JP, Braddock M, Chen YP, Zheng MH. Factors associated with efficacy of pegylated interferon-α plus ribavirin for chronic hepatitis C after renal transplantation. Gene 2014; 544:101-6. [DOI: 10.1016/j.gene.2014.04.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/20/2014] [Accepted: 04/29/2014] [Indexed: 02/08/2023]
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Heidenreich A, Pfister D, Thissen A, Piper C, Porres D. Radical retropubic and perineal prostatectomy for clinically localised prostate cancer in renal transplant recipients. Arab J Urol 2014; 12:142-8. [PMID: 26019939 PMCID: PMC4434433 DOI: 10.1016/j.aju.2014.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 01/05/2014] [Accepted: 01/12/2014] [Indexed: 11/21/2022] Open
Abstract
Objective To analyse the functional and oncological outcome of consecutive renal-transplant recipients (RTRs) with clinically localised prostate cancer who underwent radical retropubic (RRP) or perineal (RPP) prostatectomy. Patients and methods Between January 2000 and July 2011 16 patients underwent RRP (group 1) and seven RPP (group 2). In all, 200 consecutive non-RTRs served as the control group, of whom 100 each underwent RRP and RPP, respectively. The mean (range) interval between renal transplantation and RP was 95 (24–206) months, the PSA at the time of diagnosis was 4.5 (3.0–17.5) ng/mL, and the mean patient age was 64 (59–67) years. Results The mean follow-up was 39 (RRP) and 48 months (RPP). There was no deterioration in graft function. In group 1, 13 and three patients had pT2a-cpN0 and pT3a-bpN0 prostate cancer, respectively, with a Gleason score of 6, 7 and 8 in 11, three and one patients, respectively. In group 2, three and four patients had pT2a-c and pT3a-b disease, respectively, with a Gleason score of 6 and 7 in two and five, respectively. In both groups one patient had a positive surgical margin and was followed expectantly, and all patients have no evidence of disease. Wound infections developed more often in the RPP group (29% vs. 7%), but there were no Clavien grade III–V complications. All patients achieved good continence, and two need one pad/day. Conclusions RRP and RPP are suitable surgical treatments for prostate cancer in RTRs. RRP might be preferable, as it has the advantage of simultaneous pelvic lymphadenectomy and a lower risk of infectious complications.
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Affiliation(s)
| | - David Pfister
- Department of Urology, RWTH University Aachen, Germany
| | | | | | - Daniel Porres
- Department of Urology, RWTH University Aachen, Germany
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8
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Karatzas T, Bokos J, Katsargyris A, Diles K, Sotirchos G, Barlas A, Theodoropoulou E, Boletis J, Zavos G. Advanced Donor Age Alone Is Not a Risk Factor for Graft Survival in Kidney Transplantation. Transplant Proc 2011; 43:1537-43. [DOI: 10.1016/j.transproceed.2011.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 03/01/2011] [Indexed: 11/27/2022]
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Eufrásio P, Moreira P, Parada B, Nunes P, Figueiredo A, Alves R, Macário F, Mota A. Renal transplantation in recipients over 65 years old. Transplant Proc 2011; 43:117-9. [PMID: 21335167 DOI: 10.1016/j.transproceed.2010.12.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Older patients on hemodialysis have become candidates for renal transplantation, particularly in the period of increasing numbers of marginal donors. The purpose of this study was to evaluate short-term and long-term results of renal transplantation among recipients ≥65 years old for comparison with these in younger patients. PATIENTS AND METHODS We retrospectively studied 1,796 renal transplantations performed between June 1991 and May 2010, dividing the sample into 2 groups: ≥65 years old (n = 89) versus <65 years old (n = 1,707). RESULTS The mean ages were 42.17 and 67.45 years for the younger and older groups, respectively. Time of pretransplantation dialysis was significantly greater among the older group (52.76 vs 47.69 mo). There were no differences between the 2 groups regarding donor age, donor renal function, or cold ischemia times. After a mean follow-up of 73.37 versus 39.73 months for the younger versus older groups, respectively, we observed differences in initial graft function, with a greater rate of delayed graft function in the ≥65 group (28.1% vs 17.8%), and in acute rejection rate, which was higher among the younger group (19.4% vs 10.1%). Initial creatinine was better for the older group (1.71 vs 2.10 mg/dL), but similar between the groups at 10 years. Graft and patient survivals at 1, 5, and 10 years were lower among the older group. When analyzing graft survival censored for death with a functioning kidney, there were no differences between the younger and older groups: It was at 1, 5, and 10 years, namely 93.6% versus 90.6%, 87% versus 80.8%, and 76.7% versus 70.1%, respectively. CONCLUSIONS Selected recipients ≥65 years of age show good outcomes of transplantation.
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Affiliation(s)
- P Eufrásio
- Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal.
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Patel SJ, Knight RJ, Suki WN, Abdellatif A, Duhart BT, Krauss AG, Mannan S, Nezakatgoo N, Osama Gaber A. Rabbit antithymocyte induction and dosing in deceased donor renal transplant recipients over 60 yr of age. Clin Transplant 2011; 25:E250-6. [PMID: 21231963 DOI: 10.1111/j.1399-0012.2010.01393.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Antithymocyte globulin (rATG) is a commonly used induction agent in renal transplantation; however, data in older kidney recipients are limited. METHODS We reviewed charts of 301 deceased donor renal transplants who received a protocol consisting of 3-7 doses of rATG and triple maintenance therapy. Outcomes of patients >60 yr of age (n = 45) were compared to those aged 18-59 yr (n = 256). RESULTS Older recipients had more diabetics, were more likely to receive expanded criteria donor kidneys (p < 0.01), and over 30% were sensitized. Recipients >60 received less cumulative rATG (4.6 vs. 5.1 mg/kg; p < 0.01). Three-yr acute rejection was lower in the >60 group (2% vs. 16%, p < 0.01) although glomerular filtration rates were similar between groups. Actuarial graft survival was similar; however, patient survival in the >60 group at three yr was lower (80% vs. 95%; p = 0.02). Specifically, patients >60 with delayed graft function and rATG cumulative dosing >6 mg/kg had a survival of <50% by two yr. CONCLUSION Recipients over 60 yr receiving rATG induction have acceptable renal function and a low risk of rejection; however, reduced survival was noted among those receiving >6 mg/kg. These data suggest that when used, lower cumulative dosages of rATG are preferable in the older recipient.
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Affiliation(s)
- Samir J Patel
- Department of Pharmacy Department of Surgery, The Methodist Hospital, Houston, TX, USA.
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Karachristos A, Herrera A, Sifontis NM, Darrah J, Baribault C, Lee I, Leech SH, Constantinescu S, Gaughan J, Jain A, Silva P, Daller JA. Outcomes of renal transplantation in older high risk recipients: is there an age effect? J Surg Res 2010; 161:173-8. [PMID: 20189598 DOI: 10.1016/j.jss.2009.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 10/02/2009] [Accepted: 11/05/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate long-term outcomes in high risk renal transplant recipients over 60 years of age compared with those younger than 60 years of age. MATERIALS AND METHODS We analyzed outcomes in 131 consecutive renal transplant recipients at our institution between November 2001 and December 2007. Primary outcomes included incidence of delayed graft function (DGF), acute rejection, graft survival, patient survival, and incidence of infections and neoplasms. RESULTS Older recipients (Over 60 group, n = 45) received more organs from extended criteria donors (ECD) or donation after cardiac death donors (DCD) compared with younger recipients (Under 60 group, n = 86), 42% versus 17% respectively, P = 0.001. Multivariate analyses revealed that African American ethnicity and DCD donation had the greatest impact on the incidence of DGF in both groups; P < 0.05. Patient survival and graft survival beyond 1 y were similar between the two groups. CONCLUSION Our data suggest that long-term transplant outcomes in older, high risk renal transplant recipients are similar to those of younger, high risk recipients. Older recipients' age and high-risk characteristics, such as African American ethnicity and increased sensitization, should not be a contraindication to renal transplantation in the elderly.
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Abstract
There is an increase in the older incident end-stage renal disease population that is associated with an increasing prevalence of end-stage renal disease in the United States. This trend is paralleled by an increasing rate of kidney transplantation in the elderly. Although patient survival is lower in older versus younger kidney recipients, the elderly benefit from a reduction in mortality rate and improved quality of life with transplantation compared with dialysis. Immunologic, physiologic, and psychosocial factors influence transplant outcomes and should be recognized in the care of the elderly transplant patient. In this review, we discuss transplantation in the elderly patient, particularly the topics of access to transplantation, patient and graft survival, the impact of donor quality on transplant outcomes, immunology and immunosuppression of aging, and ethical considerations in the development of an equitable organ allocation scheme.
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Affiliation(s)
- Edmund Huang
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
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Abstract
The kidneys are among the most prominent body organs affected by the process of aging, as both kidney morphology and function are known to change with age. However, special challenges emerge when the elderly patient also has diabetes complicated by kidney disease. Cases frequently progress from the early stages of diabetic nephropathy to advanced kidney impairment and end-stage renal disease, and the majority of patients suffer cardiovascular complications. However, many elderly patients with diabetes will lack the classic clinical features of diabetic kidney disease. Neither the efficacy nor safety of general treatment goals such as glycemic control, hypertension management and renin–angiotensin blockade have been adequately addressed in the aging diabetic kidney patient. These basic treatments for diabetic kidney disease are extrapolated from studies of mostly middle-aged individuals. Diabetic kidney guidelines do not adequately distinguish between age groups. Aggressive management must be measured against life expectancy in the elderly. The physician should be aware of these risks. Unfortunately, many elderly diabetic chronic kidney disease/end-stage renal disease patients are not prescribed the treatments that are available. Over a third of new end-stage renal disease cases among the elderly are due to diabetic kidney disease. Prognosis is poor, even for those who receive a kidney transplant.
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Affiliation(s)
- Mark E Williams
- Renal Unit, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215, USA
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