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Gadelkareem RA, Abdelgawad AM, Reda A, Azoz NM, Zarzour MA, Mohammed N, Hammouda HM, Khalil M. Preemptive living donor kidney transplantation: Access, fate, and review of the status in Egypt. World J Nephrol 2023; 12:40-55. [PMID: 37476008 PMCID: PMC10354566 DOI: 10.5527/wjn.v12.i3.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/22/2023] [Accepted: 03/14/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Preemptive living donor kidney transplantation (PLDKT) is recommended as the optimal treatment for end-stage renal disease.
AIM To assess the rate of PLDKT among patients who accessed KT in our center and review the status of PLDKT in Egypt.
METHODS We performed a retrospective review of the patients who accessed KT in our center from November 2015 to November 2022. In addition, the PLDKT status in Egypt was reviewed relative to the literature.
RESULTS Of the 304 patients who accessed KT, 32 patients (10.5%) had preemptive access to KT (PAKT). The means of age and estimated glomerular filtration rate were 31.7 ± 13 years and 12.8 ± 3.5 mL/min/1.73 m2, respectively. Fifty-nine patients had KT, including 3 PLDKTs only (5.1% of total KTs and 9.4% of PAKT). Twenty-nine patients (90.6%) failed to receive PLDKT due to donor unavailability (25%), exclusion (28.6%), regression from donation (3.6%), and patient regression on starting dialysis (39.3%). In multivariate analysis, known primary kidney disease (P = 0.002), patient age (P = 0.031) and sex (P = 0.001) were independent predictors of achievement of KT in our center. However, PAKT was not significantly (P = 0.065) associated with the achievement of KT. Review of the literature revealed lower rates of PLDKT in Egypt than those in the literature.
CONCLUSION Patient age, sex, and primary kidney disease are independent predictors of achieving living donor KT. Despite its non-significant effect, PAKT may enhance the low rates of PLDKT. The main causes of non-achievement of PLDKT were patient regression on starting regular dialysis and donor unavailability or exclusion.
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Affiliation(s)
- Rabea Ahmed Gadelkareem
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Amr Mostafa Abdelgawad
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Ahmed Reda
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Nashwa Mostafa Azoz
- Department of Internal Medicine, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mohammed Ali Zarzour
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Nasreldin Mohammed
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Hisham Mokhtar Hammouda
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mahmoud Khalil
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
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Smith J, Harris OO, Adey D, Park M. Barriers and facilitators to the transplant process among patients living with polycystic kidney disease: a qualitative Approach. BMC Nephrol 2023; 24:119. [PMID: 37127564 PMCID: PMC10150665 DOI: 10.1186/s12882-023-03174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/18/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Kidney transplant is the gold standard for renal replacement therapy in patients with autosomal dominant polycystic kidney disease (ADPKD), which is the fourth leading cause of kidney failure. Despite the medical and economic benefits of preemptive kidney transplant over dialysis before transplant, only 9-21% of qualifying patients receive preemptive transplants. Given the low rates of preemptive transplant, the aim of this study was to determine perceived facilitators and barriers to preemptive transplant among ADPKD patients using a qualitative approach. METHODS Data were collected between July 2021 and January 2022 from virtual individual semi-structured interviews of 16 adult participants with ADPKD. Qualitative analysis of the recorded interviews was conducted to generate themes. RESULTS Our findings revealed two themes specific for facilitators to preemptive transplant (social support and patient agency) and three themes specific to barriers for preemptive transplant (inadequate social support, gaps in knowledge, and institutional and systemic policies). The results also include various subthemes and the application of these themes to the social ecological model. CONCLUSIONS These findings suggest that increasing social support and patient agency, such as through patient navigator programs and encouraging effective communication between health care providers and patients, can facilitate the transplant process. Increasing dissemination of transplant knowledge from institutions and systems to patients through paired kidney exchange education and live donor outreach can also increase timely access to preemptive kidney transplants for patients with ADPKD. Our findings are limited by our single site study in the US, which may not apply to individuals experiencing different social, cultural, and health access conditions.
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Affiliation(s)
- Juliana Smith
- University of California, San Francisco School of Medicine, 505 Parnassus Ave, San Francisco, CA, 94143, United States
| | - Orlando O Harris
- Department of Community Health Systems, School of Nursing, University of California, San Francisco 2 Koret Way, N 531E, Box 0608, San Francisco, CA, 94143, United States
| | - Deborah Adey
- Department of Medicine, Division of Nephrology, University of California, San Francisco, 400 Parnassus, ACC Box 701 KTU, Box 0532, San Francisco, CA, 94143, United States
| | - Meyeon Park
- Department of Medicine, Division of Nephrology, University of California, San Francisco, 400 Parnassus, ACC Box 701 KTU, Box 0532, San Francisco, CA, 94143, United States.
- , 500 Parnassus Ave MUW 418, Box 0532, San Francisco, CA, 94143, United States.
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King KL, Yu M, Husain SA, Patzer RE, Sandra V, Reese PP, Schold JD, Mohan S. Contribution of Estimates of Glomerular Filtration to the Extensive Disparities in Preemptive Listing for Kidney Transplant. Kidney Int Rep 2023; 8:442-454. [PMID: 36938099 PMCID: PMC10014377 DOI: 10.1016/j.ekir.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction The use of race coefficients in equations for estimated glomerular filtration rate (eGFR) may have contributed to racial disparities in access to preemptive (without dialysis exposure) kidney transplantation (Ktx). Methods In this retrospective national cohort study of incident kidney transplant candidates in the United States from 2001 to 2019, we describe temporal trends and racial disparities in preemptive listing and the distribution of eGFR at listing, using eGFR as reported and after removing the race coefficient for Black candidates. Results Among 511,686 candidates, preemptive listing increased over time, from 18% in 2001 to 33% in 2019. Non-Black candidates were listed preemptively nearly twice as frequently as Black candidates in 2019 (38% vs. 21% preemptive) and at higher eGFR values (median 15.6 vs. 15.0 ml/min per 1.73 m2). After adjusting for candidate characteristics, including listing eGFR without the race coefficient, preemptive Black candidates still had significantly lower odds of preemptive deceased donor (DD) kidney transplantation compared to non-Black candidates (odds ratio 0.87, 95% confidence interval: 0.78-0.98). Conclusions Over the last 2 decades, Black patients were consistently less likely to be listed preemptively and were listed at lower eGFR values. Adjusting for listing eGFR with the race coefficient computationally removed did not eliminate the racial disparity, suggesting that additional efforts are needed to achieve equity in preemptive transplantation beyond adopting race-free eGFR equations.
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Affiliation(s)
- Kristen L. King
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Miko Yu
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Columbia University Renal Epidemiology Group, New York, New York, USA
| | - S. Ali Husain
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Rachel E. Patzer
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vanessa Sandra
- Columbia University Renal Epidemiology Group, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Peter P. Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jesse D. Schold
- Department of Surgery, University of Colorado–Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, School of Public Health, University of Colorado–Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Columbia University Renal Epidemiology Group, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Correspondence: Sumit Mohan, Division of Nephrology, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, Ph4-124, New York, New York 10032, USA.
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4
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Lai M, Gao Y, Tavakol M, Freise C, Lee BK, Park M. Pretransplant Dialysis and Preemptive Transplant in Living Donor Kidney Recipients. KIDNEY360 2022; 3:1080-1088. [PMID: 35845334 PMCID: PMC9255866 DOI: 10.34067/kid.0007652021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/07/2022] [Indexed: 01/10/2023]
Abstract
Background The optimal timing of dialysis access placement in individuals with stage 5 CKD is challenging to estimate. Preemptive living donor kidney transplant (LDKT) is the gold-standard treatment for ESKD due to superior graft survival and mortality, but dialysis initiation is often required. Among LDKT recipients, we sought to determine which clinical characteristics were associated with preemptive transplant. Among non-preemptive LDKT recipients, we sought to determine what dialysis access was used, and their duration of use before receipt of living donor transplant. Methods We retrospectively extracted data on 569 LDKT recipients, >18 years old, who were transplanted between January 2014 and July 2019 at UCSF, including dialysis access type (arteriovenous fistula [AVF], arteriovenous graft [AVG], peritoneal dialysis catheter [PD], and venous catheter), duration of dialysis, and clinical characteristics. Results Preemptive LDKT recipients constituted 30% of our cohort and were older, more likely to be White, more likely to have ESKD from polycystic kidney disease, and less likely to have ESKD from type 2 diabetes. Of the non-preemptive patients, 26% used AVF, 0.5% used AVG, 32% used peritoneal catheter, 11% used venous catheter, and 31% used more than one access type. Median (IQR) time on dialysis for AVF/AVG use was 1.86 (0.85-3.32) years; for PD catheters, 1.12 (0.55-1.92) years; for venous catheters, 0.66 (0.23-1.69) years; and for multimodal access, 2.15 (1.37-3.72) years. Conclusions We characterized the dialysis access landscape in LDKT recipients. Venous catheter and PD were the most popular modality in the first quartile of dialysis, and patients using these modalities had shorter times on dialysis compared with those with an AVF. Venous catheter or PD can be considered a viable bridge therapy in patients with living donor availability given their shorter waitlist times. Earlier referral of patients with living donor prospects might further minimize dialysis need.
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Affiliation(s)
- Mason Lai
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Ying Gao
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Mehdi Tavakol
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Chris Freise
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Brian K. Lee
- Department of Internal Medicine, Dell Seton Medical Center, University of Texas at Austin, Austin, Texas
| | - Meyeon Park
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California
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Parmentier C, Lassalle M, Berard E, Bacchetta J, Delbet JD, Harambat J, Couchoud C, Hogan J. Setting reasonable objectives for improving preemptive kidney transplantation rates in children. Pediatr Nephrol 2020; 35:2353-2360. [PMID: 32583044 DOI: 10.1007/s00467-020-04653-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/07/2020] [Accepted: 06/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aims to develop a method to estimate the potential of preemptive kidney transplantation (PKT) by identifying patients who were transplanted after a dialysis period (non-preemptive kidney transplantation (NPKT)) despite being medically suitable for PKT. METHODS All children (< 18 years old) starting kidney replacement therapy (KRT) in France, between 2010 and 2016 and transplanted before December 31, 2017, were included. A propensity score (PS) of receiving PKT was estimated by multivariate logistic regression based on recipient medical characteristics. Healthcare use during the 24 months prior to KRT initiation was extracted from the French National Health Insurance database, and a pre-KRT follow-up of more than 18 months was considered sufficient to allow preemptive transplantation. RESULTS Among 643 patients who started KRT, 149 (23.2%) were preemptively transplanted. Using PS stratification, among 391 NPKT patients, we identified 145 patients (37%) suitable for PKT, according to clinical characteristics. Mean age was 12.3 years, 67% were males, and 56% had urological abnormalities. Among those 145 patients, we identified 79 NPKT patients who started on dialysis despite early referral to a nephrologist (more than 18 months prior to KRT initiation). CONCLUSIONS This method estimates a potential of 228 (149 + 79) PKT (35%) among pediatric patients in France. A similar method could be used in adults or in other countries. Estimation of the rate of patients with CKD stage 5 medically suitable for PKT will be of interest for health policy makers when setting up objectives for improvement in preemptive kidney transplant access.
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Affiliation(s)
- Cyrielle Parmentier
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP.6, 75012, Paris, France.
- REIN Registry, Agence de la Biomedecine, La Plaine Saint-Denis, France.
| | - Mathilde Lassalle
- REIN Registry, Agence de la Biomedecine, La Plaine Saint-Denis, France
| | - Etienne Berard
- Pediatric Nephrology Unit, CHU de Nice-Hôpital, Nice, France
| | | | - Jean-Daniel Delbet
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP.6, 75012, Paris, France
| | - Jerome Harambat
- Pediatric Nephrology Unit, CHU de Bordeaux, Bordeaux, France
| | - Cécile Couchoud
- REIN Registry, Agence de la Biomedecine, La Plaine Saint-Denis, France
| | - Julien Hogan
- Pediatric Nephrology Unit, Robert-Debré Hospital, APHP, Paris, France
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6
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Atkinson MA, Roem JL, Gajjar A, Warady BA, Furth SL, Muñoz A. Mode of initial renal replacement therapy and transplant outcomes in the chronic kidney disease in children (CKiD) study. Pediatr Nephrol 2020; 35:1015-1021. [PMID: 31797095 PMCID: PMC7278892 DOI: 10.1007/s00467-019-04416-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/16/2019] [Accepted: 11/08/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Kidney transplant is the renal replacement therapy (RRT) of choice for children with end stage kidney disease (ESKD). Only 21.3% of children who initiate RRT receive a preemptive kidney transplant (PKT). We characterized the transition to RRT in children in the CKiD cohort including the prevalence of dialysis as first RRT vs. PKT and graft survival. METHODS 258 children enrolled in CKiD have initiated RRT, and 202 had post-RRT initiation data collected through phone or in-person follow-up. Characteristics by first RRT modality were compared using Chi-square and Kruskal-Wallis tests. Parametric-accelerated failure time models were fit for transplantation. Graft failure was characterized using Kaplan-Meier methods and log rank tests. RESULTS Sixty-one percent received dialysis as first RRT modality and 39% PKT. Those with PKT were less likely to have glomerular disease and to be African-American, and had higher household-income. African-American subjects were nearly twice as likely to undergo dialysis prior to transplant. Those with a living donor and a college-educated mother had 40%-decreased odds of being dialysis experienced. Children with PKT were more likely to receive a living donor transplant. Only 5% of PKT subjects had graft failure by 4 years compared to 16% of those initially treated with dialysis (p = 0.092); however, after adjustment the effect of dialysis exposure was attenuated (p = 0.206). CONCLUSION CKiD subjects undergo PKT more often compared to nationally-reported rates, and are more likely to receive a kidney transplant within 1 year of starting dialysis. African-American race and lower household-income are associated with decreased access to PKT.
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Viršilas E, Čerkauskienė R, Masalskienė J, Rudaitis Š, Dobilienė D, Jankauskienė A. Renal Replacement Therapy in Children in Lithuania: Challenges, Trends, and Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E78. [PMID: 30400223 PMCID: PMC6262335 DOI: 10.3390/medicina54050078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Pediatric renal replacement therapy (RRT) in Lithuania resumed in 1994 after a 12-year pause in renal transplantation. Management of end stage renal disease (ESRD) has changed, and outcomes have improved over decades. Our aim was to evaluate the dynamics of RRT in Lithuania in the period 1994⁻2015, describe its distinctive features, and compare our results with other countries. Materials and Methods: Data between 1994 and 2015 were collected from patients under the age of 18 years with ESRD receiving RRT. The data included: Hemodialysis (HD), peritoneal dialysis (PD), transplantation incidence and prevalence, transplant waiting time, dialysis modalities before transplantation, causes of ESRD and gender distribution in transplanted patients, and patient and graft survival. Results: RRT incidence and prevalence maintained an increase up until 2009. Sixty-four transplantations were performed. Juvenile nephronophthisis (25.9%) was the primary cause of ESRD in transplanted children. The transplant waiting time median was 8.0 months. The male to female ratio post-transplantation was 1.02. Patient survival after transplantation at 10 years was 90.0%, while graft survival for living (related) was 77.0% and 51.1% for deceased. Twelve patients died while on RRT. Conclusions: RRT numbers are increasing in Lithuania. HD is the primary treatment of choice before transplantation, with continued low numbers of preemptive transplantation. Patient survival post-transplantation is favorable, though graft survival is less satisfactory.
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Affiliation(s)
- Ernestas Viršilas
- Institute of Clinical Medicine, Vilnius University, LT-08406 Vilnius, Lithuania.
| | - Rimantė Čerkauskienė
- Institute of Clinical Medicine, Vilnius University, LT-08406 Vilnius, Lithuania.
| | - Jūratė Masalskienė
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
| | - Šarūnas Rudaitis
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
| | - Diana Dobilienė
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
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Habbous S, McArthur E, Sarma S, Begen MA, Lam NN, Manns B, Lentine KL, Dipchand C, Litchfield K, McKenzie S, Garg AX. Potential implications of a more timely living kidney donor evaluation. Am J Transplant 2018; 18:2719-2729. [PMID: 29575655 DOI: 10.1111/ajt.14732] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/08/2018] [Accepted: 03/05/2018] [Indexed: 01/25/2023]
Abstract
Living donor kidney transplantation is the most promising way to avoid or minimize the amount of time a recipient spends on dialysis before transplantation. We studied 887 living kidney donors at 5 transplant centers in Ontario, Canada, who started their evaluation and donated between April 2006 and March 2014. Using a series of hypothetical scenarios, we estimated the impact of an earlier living donor evaluation completion and donation on the number pre-emptive transplants, the time spent on dialysis, healthcare cost savings from averted dialysis costs (CAD $2016), and the number of additional transplants. During the study period, if the donor transplants occurred 3 months earlier, the healthcare system would save on average $12 055 (standard deviation [SD] $13 594) per recipient; 21 recipients could have avoided dialysis altogether, and 57 additional transplants (a 26% increase) could have occurred each year. For the 220 living kidney donor transplants performed in Ontario, Canada, each year, this translates to a total annual cost savings of $2.7M. In conclusion, a more timely evaluation of living donor candidates and their intended recipients may increase the supply of kidneys for transplantation. Improved evaluation efficiency may also yield more pre-emptive transplants and substantial healthcare cost savings through averted dialysis costs.
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Affiliation(s)
- Steven Habbous
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Sisira Sarma
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Mehmet A Begen
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,Ivey School of Business, Western University, London, ON, Canada
| | - Ngan N Lam
- University of Alberta, Edmonton, AB, Canada
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Kenneth Litchfield
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (CAN-SOLVE CKD) patient council, London, ON, Canada
| | - Susan McKenzie
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (CAN-SOLVE CKD) patient council, London, ON, Canada.,Kidney Foundation of Canada, London, ON, Canada
| | - Amit X Garg
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
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Mursawa H, Hatakeyama S, Yamamoto H, Tanaka Y, Soma O, Matsumoto T, Yoneyama T, Hashimoto Y, Koie T, Fujita T, Murakami R, Saitoh H, Suzuki T, Narumi S, Ohyama C. Slow Progression of Aortic Calcification Is a Potential Benefit of Pre-emptive Kidney Transplantation. Transplant Proc 2018; 50:145-149. [PMID: 29407299 DOI: 10.1016/j.transproceed.2017.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/05/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Pre-emptive kidney transplantation (PKT) is expected to improve graft and cardiovascular event-free survival compared with standard kidney transplantation. Aortic calcification is reported to be closely associated with renal dysfunction and cardiovascular events; however, its implication in PKT recipients remains incompletely explored. This aim of this study was to evaluate whether PKT confers a protective effect on aortic calcification, renal function, graft survival, and cardiovascular event-free survival. METHODS One hundred adult patients who underwent renal transplantation between January 1996 and March 2016 at Hirosaki University Hospital and Oyokyo Kidney Research Institute were included. Among them, 19 underwent PKT and 81 patients underwent pretransplant dialysis. We retrospectively compared pretransplant and post-transplant aortic calcification index (ACI), renal function (estimated glomerular filtration rate [eGFR]), and graft and cardiovascular event-free survivals between the 2 groups. RESULTS The median age of this cohort was 45 years. Preoperative ACI was significantly lower in PKT recipients. There were no significant differences between the 2 groups regarding postoperative eGFR, graft survival, and cardiovascular event-free survival. However, the ACI progression rate (ΔACI/y) was significantly lower in PKT recipients than in those who underwent pretransplant dialysis. Higher ACI was significantly associated with poor cardiovascular event-free survival. CONCLUSIONS PKT is beneficial in that it contributes to the slow progression of after transplantation. Although we could not observe significant differences in graft and cardiovascular event-free survivals between the 2 groups, slow progression of aortic calcification showed a potential to decrease cardiovascular events in PKT recipients during long-term follow-up.
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Affiliation(s)
- H Mursawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - S Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - H Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Y Tanaka
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - O Soma
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Matsumoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Y Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Fujita
- Departments of Cardiology, Respiratory Medicine, and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - R Murakami
- Departments of Cardiology, Respiratory Medicine, and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - H Saitoh
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - T Suzuki
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - S Narumi
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - C Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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10
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Tan Q, Song T, Jiang Y, Qiu Y, Liu J, Huang Z, Wang X, Lin T. Factors affecting willingness to receive a kidney transplant among hemodialysis patients in West China: A cross-sectional survey. Medicine (Baltimore) 2017; 96:e6722. [PMID: 28471966 PMCID: PMC5419912 DOI: 10.1097/md.0000000000006722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Many factors are associated with the willingness of ESRD patients to receive a kidney transplant. No data are available for patients in China. The study aim was to describe the attitudes toward transplantation in a cohort of patients at a single dialysis center in China.A study questionnaire derived from previously published literature was completed by 239 hemodialysis outpatients. Factors associated with willingness to receive a transplant were identified by univariate and multivariate logistic regression analyses.The respondents were primarily men 50.7 ± 15.1 years of age; 46.4% were willing to receive a transplant. Younger age (OR = 0.928, 95% CI: 0.898-0.959), good self-reported health (OR = 0.203, 95% CI: 0.081-0.51), and awareness of the benefits of transplantation (OR = 0.195, 95% CI: 0.083-0.456) were less likely to deny the transplant. Patients ≤60 years of age were about 13 times more likely to favor transplantation than those >60 years of age (OR = 12.99, 95% CI: 3.75-45.45). For every 10 years under 60, participants were 2.16 times more willing to receive a kidney transplant (OR = 2.16, 95% CI: 1.53-3.02). Older patients were also less likely to be referred for evaluation (OR = 0.955, 95% CI: 0.923-0.989, P = .009).The percentage of ESRD patients in China, particularly older patients, who are willing to accept a transplant, is relatively low. A better understanding of the benefits of transplantation is needed to increase their acceptance.
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Affiliation(s)
| | - Turun Song
- Urology Research Institute/Department of Urology/Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yamei Jiang
- Urology Research Institute/Department of Urology/Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yang Qiu
- Urology Research Institute/Department of Urology/Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Jingpeng Liu
- Urology Research Institute/Department of Urology/Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Zhongli Huang
- Urology Research Institute/Department of Urology/Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xianding Wang
- Urology Research Institute/Department of Urology/Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Tao Lin
- Urology Research Institute/Department of Urology/Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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11
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Amaral S, Sayed BA, Kutner N, Patzer RE. Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease. Kidney Int 2016; 90:1100-1108. [PMID: 27653837 PMCID: PMC5072842 DOI: 10.1016/j.kint.2016.07.028] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/24/2016] [Accepted: 07/21/2016] [Indexed: 01/31/2023]
Abstract
Kidney transplantation is the preferred treatment for pediatric end-stage renal disease (ESRD). Preemptive transplantation avoids the increased morbidity and mortality of dialysis. Yet, previous studies have not demonstrated significant graft or patient survival benefits for children undergoing transplantation preemptively versus nonpreemptively. These previous studies were limited by small samples sizes and low rates of adverse events. Here we compared graft failure and mortality rates using Kaplan-Meier methods and Cox regression among a large national cohort of children with ESRD undergoing preemptive versus nonpreemptive kidney transplantation between 2000 and 2012. Among 7527 pediatric kidney transplant recipients in the United States Renal Data System, 1668 underwent preemptive transplantation. Over a median 4.8 years follow-up, 1314 experienced graft failure, and over a median 5.2 years of follow-up, 334 died. Dialysis exposure versus preemptive transplantation conferred a higher risk of graft failure (hazard ratio 1.32; 95% confidence interval: 1.10-1.56) and a higher risk of death (hazard ratio 1.69; 95% confidence interval: 1.22-2.33) in multivariable analysis. Compared with children undergoing preemptive transplantation, children on dialysis for >1 year had a 52% higher risk of graft failure and those on dialysis >18 months had an 89% higher risk of death, regardless of donor source. Thus, preemptive transplantation is associated with substantial benefits in allograft and patient survival among children with ESRD, particularly when compared with children who receive dialysis for >1 year. These findings support policies to promote early access to transplantation and avoidance of dialysis for children with ESRD whenever feasible.
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Affiliation(s)
- Sandra Amaral
- Division of Nephrology, The Children's Hospital of Philadelphia, Departments of Pediatrics and Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Blayne A Sayed
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy Kutner
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rachel E Patzer
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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12
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Arze Aimaretti L, Arze S. Preemptive Renal Transplantation—The Best Treatment Option for Terminal Chronic Renal Failure. Transplant Proc 2016; 48:609-11. [DOI: 10.1016/j.transproceed.2016.02.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Ilori TO, Enofe N, Oommen A, Odewole O, Ojo A, Plantinga L, Pastan S, Echouffo-Tcheugui JB, McClellan W. Factors affecting willingness to receive a kidney transplant among minority patients at an urban safety-net hospital: a cross-sectional survey. BMC Nephrol 2015; 16:191. [PMID: 26588895 PMCID: PMC4654893 DOI: 10.1186/s12882-015-0186-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 11/09/2015] [Indexed: 11/21/2022] Open
Abstract
Background In the US, African Americans (AAs) are four times more likely to develop end stage renal disease (ESRD) but half as likely to receive a kidney transplant as whites. Patient interest in kidney transplantation is a fundamental step in the kidney transplant referral process. Our aim was to determine the factors associated with the willingness to receive a kidney transplant among chronic kidney disease (CKD) patients in a predominantly minority population. Methods CKD patients from an outpatient nephrology clinic at a safety-net hospital (n = 213) participated in a cross-sectional survey from April to June, 2013 to examine the factors associated with willingness to receive a kidney transplant among a predominantly minority population. The study questionnaire was developed from previously published literature. Multivariable logistic regression analysis was used to determine factors associated with willingness to undergo a kidney transplant. Results Respondents were primarily AAs (91.0 %), mostly female (57.6 %) and middle aged (51.6 %). Overall, 53.9 % of participants were willing to undergo a kidney transplant. Willingness to undergo a kidney transplant was associated with a positive perception towards living kidney donation (OR 7.31, 95 % CI: 1.31–40.88), willingness to attend a class about kidney transplant (OR = 7.15, CI: 1.76–29.05), perception that a kidney transplant will improve quality of life compared to dialysis (OR = 5.40, 95 % CI: 1.97–14.81), and obtaining information on kidney transplant from other sources vs. participant’s physician (OR =3.30, 95 % CI: 1.13–9.67), when compared with their reference groups. Conclusion It is essential that the quality of life benefits of kidney transplantation be known to individuals with CKD to increase their willingness to undergo kidney transplantation. Availability of multiple sources of information and classes on kidney transplantation may also contribute to willingness to undergo kidney transplantation, especially among AAs. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0186-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Titilayo O Ilori
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA. .,Renal Division, Emory University School of Medicine, 1639 Pierce Drive, Atlanta GA. Clifton Road, Atlanta, Georgia, 30322, USA.
| | - Nosayaba Enofe
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA.
| | - Anju Oommen
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA.
| | - Oluwaseun Odewole
- Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, Georgia, USA.
| | - Akinlolu Ojo
- Department of Medicine, Renal Division, University of Michigan, Ann Arbor, Michigan, USA.
| | - Laura Plantinga
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA.
| | - Stephen Pastan
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA. .,Emory Transplant Center, Emory Healthcare, Atlanta, Georgia, USA.
| | - Justin B Echouffo-Tcheugui
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. .,MedStar Health, Baltimore, Maryland, USA.
| | - William McClellan
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA. .,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
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14
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Nakamura T, Ushigome H, Nakao T, Harada S, Koshino K, Suzuki T, Ito T, Nobori S, Yoshimura N. Advantages and disadvantages of pre-emptive kidney transplantation: results from a single transplantation center. Transplant Proc 2015; 47:626-9. [PMID: 25891699 DOI: 10.1016/j.transproceed.2014.09.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/29/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is a growing tendency to perform pre-emptive kidney transplantation (PKT). However, less research has been performed on outcomes of PKT and kidney transplantation (KT) after long-term dialysis (LD). METHODS To elucidate advantages of PKT to KTLD, 96 patients who underwent living-donor KT at our university from 2000 to 2011 were enrolled for this study: 64 patients in the PKT0 (0 months dialysis) group; 14 patients in the PKT-3 group (less than 3 months dialysis); 18 patients in the LD (dialysis > 120 months) group. All recipients were assessed for patients' survival, graft survival, urinary tract infection, laboratory data, episodes of acute rejection, cytomegalovirus-related diseases, and other significant infectious diseases which required hospitalization. RESULTS Although there were no significant differences in 5-year graft survival (93.8% in PKT0, 85.7% in PKT-3, and 83.7% in control), 5-year patient survival is better in the PKT0 group (96.9%) and the PKT-3 group (92.9%) compared to 88.9% in the control group. Urinary tract infection is clearly correlated with the LD group (44.4% in the LD group vs 19.2% in the PKT group) primarily due to atrophic bladder and subsequent vesicoureteral reflux. Slightly higher rates of acute rejection were found in the PKT groups (30.8% vs 26.3%). CONCLUSION This study revealed that there are both advantages and disadvantages of PKT. It is clear, therefore, that PKT can be recommended for end-stage renal disease patients provided enough attention is paid to the onset of acute rejection.
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Affiliation(s)
- T Nakamura
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - H Ushigome
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Nakao
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - S Harada
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - K Koshino
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Suzuki
- Department of Organ Interaction Research Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Ito
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - S Nobori
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - N Yoshimura
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Organ Interaction Research Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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15
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Abstract
BACKGROUND Kidney transplantation is the best treatment method for end-stage renal disease. Outcomes of the preemptive kidney transplantation are better than non-preemptive kidney transplantation. Preemptive kidney transplantation is performed as a small percentage of kidney transplantations worldwide. We performed 15 preemptive kidney transplantations from living donors between November 2010 and April 2014. We present our experiences and outcomes for these 15 preemptive kidney transplantations. METHODS We performed 110 kidney transplantations between November 2010 and April 2014. Fifteen of the kidney transplantations were performed from living related donors to preemptive recipients. These 15 preemptive recipients and their donors' data were collected and retrospectively analyzed. RESULTS The mean age of recipients and donors was 37.2 years (range, 4-60) and 50.6 years (range, 28-64), respectively. The male-female ratios were 10:5 in the recipients and 8:7 in the donors. Nine left kidneys and 6 right kidneys were recovered. Nine kidneys had a single artery; the other 6 kidneys had 2 renal arteries. The mean warm ischemic time was 219.5 seconds (range, 90-480). The mean hospitalization times were 5.9 days (range, 4-10) and 4.9 days (range, 3-9) for the recipients and the donors, respectively. The mean follow-up time was 20.3 months (range, 0.5-37) for recipients. Graft survival was 100% in this period. BK virus nephropathy occurred in only 1 pediatric recipient. One patient had a recurrent disease that was the cause of the renal failure. They graft functions were stable. No kidney was lost from rejection, technical causes, infection, or recurrent disease. The donors live their lives with no problems. CONCLUSIONS Preemptive kidney transplantation is a better therapeutic option than is non-preemptive kidney transplantation for patients with chronic renal failure. Kidney transplantation should be performed if possible before beginning dialysis for these patients.
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16
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Patzer RE, Sayed BA, Kutner N, McClellan WM, Amaral S. Racial and ethnic differences in pediatric access to preemptive kidney transplantation in the United States. Am J Transplant 2013; 13:1769-81. [PMID: 23731389 PMCID: PMC3763919 DOI: 10.1111/ajt.12299] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 03/20/2013] [Accepted: 03/31/2013] [Indexed: 01/25/2023]
Abstract
Preemptive kidney transplantation is the optimal treatment for pediatric end stage renal disease patients to avoid increased morbidity and mortality associated with dialysis. It is unknown how race/ethnicity and poverty influence preemptive transplant access in pediatric. We examined the incidence of living donor or deceased donor preemptive transplantation among all black, white, and Hispanic children (<18 years) in the United States Renal Data System from 2000 to 2009. Adjusted risk ratios for preemptive transplant were calculated using multivariable-adjusted models and examined across health insurance and neighborhood poverty levels. Among 8,053 patients, 1117 (13.9%) received a preemptive transplant (66.9% from LD, 33.1% from DD). In multivariable analyses, there were significant racial/ethnic disparities in access to LD preemptive transplant where blacks were 66% (RR = 0.34; 95% CI: 0.28-0.43) and Hispanics 52% (RR = 0.48; 95% CI: 0.35-0.67) less likely to receive a LD preemptive transplant versus whites. Blacks were 22% less likely to receive a DD preemptive transplant versus whites (RR = 0.78, 95% CI: 0.57-1.05), although results were not statistically significant. Future efforts to promote equity in preemptive transplant should address the critical issues of improving access to pre-ESRD nephrology care and overcoming barriers in living donation, including obstacles partially driven by poverty.
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Affiliation(s)
- Rachel E Patzer
- Emory University, Department of Surgery, Emory Transplant Center, Atlanta, GA,Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
| | - Blayne A Sayed
- Emory University, Department of Surgery, Emory Transplant Center, Atlanta, GA
| | - Nancy Kutner
- Emory University, USRDS Rehabilitation/QoL Special Studies Center, Atlanta, GA
| | - William M McClellan
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA,Emory University, Division of Nephrology, WMB, Room 338, 1639 Pierce Dr., Atlanta, GA 30322
| | - Sandra Amaral
- The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Department of Pediatrics and Department of Biostatistics and Epidemiology, Philadelphia, PA
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17
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Sayin B, Colak T, Tutal E, Sezer S. Comparison of preemptive kidney transplant recipients with nonpreemptive kidney recipients in single center: 5 years of follow-up. Int J Nephrol Renovasc Dis 2013; 6:95-9. [PMID: 23761978 PMCID: PMC3674016 DOI: 10.2147/ijnrd.s42042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND For suitable patients with end-stage renal disease, kidney transplantation (KT) is the best renal replacement therapy, resulting in lower morbidity and mortality rates and improved quality of life. Preemptive kidney transplantation (PKT) is defined as transplantation performed before initiation of maintenance dialysis and reported to be associated with superior outcomes of graft and patient survival. In our study, we aimed to compare the 5-year outcomes of PKT and nonpreemptive kidney transplantation (NPKT) patients who received KT in our center, to define the differences according to complications, comorbidities, adverse effects, clinical symptoms, periodical laboratory parameters, rejection episodes, graft, and patient survival. METHODS One hundred kidney transplantation (37 PKT, 63 NPKT) recipients were included in our study. All patients were evaluated for adverse effects, complications, comorbidities, clinical symptoms, monthly laboratory parameters, acute rejection episodes, graft, and patient survival. RESULTS Acute rejection episodes were found to be significantly correlated with graft loss in both groups (P = 0.02 and P = 0.01, respectively). Hypertension after transplantation was diagnosed by ambulatory blood pressure measurement in 74 of 100 patients. Twenty-five of 37 (67.6%) of Group 1 (PKT) recipients had hypertension while 54 of 63 (85.4%) of Group 2 (NPKT) had hypertension. The incidence of hypertension between two groups was statistically significant (P = 0.03), but this finding was not correlated to graft survival (P = 0.07). Some patients had serious infections, requiring hospitalization, and were treated immediately. Infection rates between the two groups were 10.8% for Group 1 patients and 31.7% for Group 2 patients and were statistically significant (P = 0.02). Infection, requiring hospitalization, was found to be statistically correlated to graft loss in only NPKT patients (P = 0.00). CONCLUSION While the comparison of PKT and graft and patient survival with NPKT is poorer than we expected, lower morbidity rates of hypertension and infection are similar with recent data. Avoidance of dialysis-associated comorbidities, diminished immune response, and cardiovascular complications are the main benefits of PKT.
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Affiliation(s)
- Burak Sayin
- Department of Nephrology, Baskent University Faculty of Medicine, Ankara, Turkey
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18
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Bozkurt B, Kumru AÖ, Dumlu EG, Tokaç M, Koçak H, Süleymanlar G, Dinçkan A. Patient and graft survival after pre-emptive versus non-pre-emptive kidney transplantation: a single-center experience from Turkey. Transplant Proc 2013; 45:932-4. [PMID: 23622591 DOI: 10.1016/j.transproceed.2013.02.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to report the graft and patients survival of pre-emptive and non-pre-emptive kidney transplantations performed in our center. METHODS The 859 subjects showed a mean age of 36.1 years and included 64.6%; males, who received grafts from living (n = 665) or deceased (n = 194) donors between January 2008 and June 2011. We reviewed their medical records retrospectively, to separately pre-emptive versus non-pre-emptive recipients for year transplant outcomes. RESULTS Among the 859 patients, 153 (17.8%) underwent pre-emptive and 706 (82.2%), non-pre-emptive kidney transplantations. The rate of living donors was higher in the pre-emptive group (97.4% vs 73%, respectively). The 1-year graft survivals were 99.3% and 95.8% in pre-emptive and non-pre-emptive transplantation groups, respectively (P > .05). There was no significant difference between groups with respect to patient survival at 1 year (P > .05). CONCLUSION In conclusion, graft and patient survival rates between pre-emptive and non-pre-emptive kidney transplantation cases were comparable at 1 year. Pre-emptive kidney transplantation, which eliminates hemodialysis costs and complications, should be preferred as the optimal renal replacement therapy for end-stage renal disease patients.
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Affiliation(s)
- B Bozkurt
- Atatürk Training and Research Hospital, Clinic of Surgery, Organ Transplantation Center, Ankara, Turkey.
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Grams ME, Massie AB, Coresh J, Segev DL. Trends in the timing of pre-emptive kidney transplantation. J Am Soc Nephrol 2011; 22:1615-20. [PMID: 21617118 PMCID: PMC3171933 DOI: 10.1681/asn.2011010023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 03/21/2011] [Indexed: 11/03/2022] Open
Abstract
Pre-emptive kidney transplantation is considered the best available renal replacement therapy, but no guidelines exist to direct its timing during CKD progression. We used a national cohort of 19,471 first-time pre-emptive kidney transplant recipients between 1995-2009 to evaluate patterns and implications of transplant timing. Mean estimated GFR (eGFR) at the time of pre-emptive transplant increased significantly over time, from 9.2 ml/min/1.73 m(2) in 1995 to 13.8 ml/min/1.73 m(2) in 2009 (P<0.001). Patients with eGFR ≥ 15 ml/min/1.73 m(2) represented an increasing proportion of pre-emptive transplant recipients, from 9% in 1995 to 35% in 2009; the trend for patients with eGFR ≥ 10 was similar (30% to 72%). We did not detect statistically significant differences in patient survival or death-censored graft survival between strata of eGFR at the time of transplant, either in the full cohort or in subgroup analyses of patients who might theoretically benefit from earlier pre-emptive transplantation. In summary, pre-emptive kidney transplantation is occurring at increasing levels of native kidney function. Earlier transplantation does not appear to associate with patient or graft survival, suggesting that earlier pre-emptive transplantation may subject donors and recipients to premature operative risk and waste the native kidney function of recipients.
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Affiliation(s)
- Morgan E Grams
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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