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Jadlowiec CC, Heilman R. Misunderstood and Underused Acute Kidney Injury Kidneys: How Do We Move the Needle Forward? J Am Coll Surg 2024; 239:208-209. [PMID: 38407392 DOI: 10.1097/xcs.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
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Webb CJ, McCracken E, Jay CL, Sharda B, Garner M, Farney AC, Orlando G, Reeves-Daniel A, Mena-Gutierrez A, Sakhovskaya N, Stratta B, Stratta RJ. Single center experience and literature review of kidney transplantation from non-ideal donors with acute kidney injury: Risk and reward. Clin Transplant 2023; 37:e15115. [PMID: 37646473 DOI: 10.1111/ctr.15115] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION There is limited experience transplanting kidneys from either expanded criteria donors (ECD) or donation after circulatory death (DCD) deceased donors with terminal acute kidney injury (AKI). METHODS AKI kidneys were defined by a donor terminal serum creatinine level >2.0 mg/dL whereas non-ideal deceased donor (NIDD) kidneys were defined as AKI/DCD or AKI/ECDs. RESULTS From February 2007 to March 2023, we transplanted 266 single AKI donor kidneys including 29 from ECDs, 29 from DCDs (n = 58 NIDDs), and 208 from brain-dead standard criteria donors (SCDs). Mean donor age (43.7 NIDD vs. 33.5 years SCD), KDPI (66% NIDD vs. 45% SCD), and recipient age (57 NIDD vs. 51 years SCD) were higher in the NIDD group (all p < .01). Mean waiting times (17.8 NIDD vs. 24.2 months SCD) and dialysis duration (34 NIDD vs. 47 months SCD) were shorter in the NIDD group (p < .05). Delayed graft function (DGF, 48%) and 1-year graft survival (92.7% NIDD vs. 95.9% SCD) was similar in both groups. Five-year patient and kidney graft survival rates were 82.1% versus 89.9% and 82.1% versus 75.2% (both p = NS) in the NIDD versus SCD groups, respectively. CONCLUSIONS The use of kidneys from AKI donors can be safely liberalized to include selected ECD and DCD donors.
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Affiliation(s)
- Christopher J Webb
- Department of Surgery, Section of Transplantation and the Section of Nephrology, Winston-Salem, North Carolina, USA
| | - Emily McCracken
- Department of Surgery, Section of Transplantation and the Section of Nephrology, Winston-Salem, North Carolina, USA
| | - Colleen L Jay
- Department of Surgery, Section of Transplantation and the Section of Nephrology, Winston-Salem, North Carolina, USA
| | - Berjesh Sharda
- Department of Surgery, Section of Transplantation and the Section of Nephrology, Winston-Salem, North Carolina, USA
| | - Matthew Garner
- Department of Surgery, Section of Transplantation and the Section of Nephrology, Winston-Salem, North Carolina, USA
| | - Alan C Farney
- Department of Surgery, Section of Transplantation and the Section of Nephrology, Winston-Salem, North Carolina, USA
| | - Giuseppe Orlando
- Department of Surgery, Section of Transplantation and the Section of Nephrology, Winston-Salem, North Carolina, USA
| | - Amber Reeves-Daniel
- Department of Medicine, Section of Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Alejandra Mena-Gutierrez
- Department of Medicine, Section of Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Natalia Sakhovskaya
- Department of Medicine, Section of Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Bobby Stratta
- Department of Surgery, Section of Transplantation and the Section of Nephrology, Winston-Salem, North Carolina, USA
| | - Robert J Stratta
- Department of Surgery, Section of Transplantation and the Section of Nephrology, Winston-Salem, North Carolina, USA
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Al Tamimi AR, Aljaafri BA, Alhamad F, Alhoshan S, Rashidi A, Dawsari B, Aljaafri ZA. Comorbid Conditions in Kidney Transplantation: Outcome Analysis at King Abdulaziz Medical City. Cureus 2023; 15:e41355. [PMID: 37546132 PMCID: PMC10399478 DOI: 10.7759/cureus.41355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Kidney transplantation is most commonly performed for end-stage renal disease (ESRD) and provides the best chance for a cure. The surgery is shown to be beneficial to a patient's quality of life after transplantation in multiple studies. But graft failure is a serious consequence that might happen. The term graft failure refers to the failure of a transplanted kidney to function properly. There are various reasons why this can happen, such as rejection, infection, or medication complications. METHODS A retrospective cohort study of comorbid conditions in patients who underwent renal transplantation at King Abdulaziz Medical City (KAMC) between 2016 and 2022. Data were collected by chart review using the BestCare system. The data collected included patients' demographics, comorbidities, calculated Charlson Comorbidity Index (CCI), surgery-related data, laboratory data, and the outcome of transplantation. The categorical data were presented using percentages and frequencies, while the numerical data were presented as mean and standard deviation. The Chi-square test was used for inferential statistics to find the association between categorical variables. RESULTS A total of 669 patients were included in the current study. Of these, 422 (63.1%) were men, and the mean age was 44 years. The incidence of graft failure within one year at KAMC was found to be 1.2% (eight cases). Regarding the CCI and its association with graft failure within one year, 37 (5.5%) patients had a myocardial infarction (MI) and 17 (2.5%) had congestive heart failure; however, no patients with MI or congestive heart failure experienced graft failure, and no significant association was found between MI or congestive heart failure and graft failure (p-value = 1.000 for both). A total of 417 (62.3%) patients had no or diet-controlled diabetes, 122 (18.2%) had uncomplicated diabetes mellitus (DM), and 130 (19.4%) had end-organ damage. DM and graft failure were not significantly associated (p-value = 1.000). A total of 286 (42.8%) patients had ESRD of unknown etiology, 109 (16.3%) patients had ESRD caused by diabetic nephropathy, and 100 (14.9%) had ESRD resulting from hypertension, apart from other causes. CONCLUSION Most patients were found to have ESRD of unknown etiology and the most frequently reported known risk factor for ESRD and subsequent transplantation was found to be diabetic nephropathy, followed by hypertension.
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Affiliation(s)
- Abdulrahman R Al Tamimi
- Hepatobiliary Sciences and Organ Transplantation, King Abdulaziz Medical City, Riyadh, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Biostatistics, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Bader A Aljaafri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Fahad Alhamad
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Sultan Alhoshan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Awatif Rashidi
- Hepatobiliary Sciences and Organ Transplantation, King Abdulaziz Medical City, Riyadh, SAU
| | - Basayel Dawsari
- Hepatobiliary Sciences and Organ Transplantation, King Abdulaziz Medical City, Riyadh, SAU
| | - Ziad A Aljaafri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Garner M, Jay CL, Sharda B, Webb C, Farney AC, Orlando G, Rogers J, Reeves-Daniel A, Mena-Gutierrez A, Sakhovskaya N, Stratta B, Stratta RJ. Long-term outcomes of kidney transplantation from deceased donors with terminal acute kidney injury: Single center experience and literature review. Clin Transplant 2023; 37:e14886. [PMID: 36524320 DOI: 10.1111/ctr.14886] [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: 09/07/2022] [Revised: 11/05/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Long-term outcomes of kidney transplantation from deceased donors (DDKTs) with terminal acute kidney injury (AKI) are not well defined. METHODS Single center retrospective review of DDKTs from 1/31/07-12/31/19. AKI kidneys were defined by a doubling of the donor's admission serum creatinine (SCr) level AND a terminal SCr ≥2.0 mg/dl. RESULTS A total of 188 AKI DDKTs were performed, including 154 from brain-dead standard criteria donors (SCD). Mean donor age was 36 years and mean Kidney Donor Profile Index was 50%; mean admission and terminal SCr levels were 1.3 and 3.1 mg/dl, respectively. With a mean follow-up of 94 months (median 89 months), overall patient (both 71.3%) and graft survival (54% AKI vs. 57% non-AKI) rates were comparable to concurrent DDKTs from brain-dead non-AKI SCDs (n = 769). Delayed graft function (DGF) was higher in AKI kidney recipients (47% vs. 20% non-AKI DDKTs, p < .0001). DGF was associated with lower graft survival in recipients of both AKI and non-AKI SCD kidneys but the impact was earlier and more pronounced in non-AKI recipients. CONCLUSIONS Despite having more than twice the incidence of DGF, kidneys from deceased donors with terminal AKI have long-term outcomes comparable to non-AKI SCD kidneys and represent a safe and effective method to expand the donor pool.
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Affiliation(s)
- Matthew Garner
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Colleen L Jay
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Berjesh Sharda
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Christopher Webb
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Alan C Farney
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Giuseppe Orlando
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jeffrey Rogers
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Amber Reeves-Daniel
- Department of Medicine, Section of Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Alejandra Mena-Gutierrez
- Department of Medicine, Section of Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Natalia Sakhovskaya
- Department of Medicine, Section of Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Bobby Stratta
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Robert J Stratta
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Mansour SG, Khoury N, Kodali R, Virmani S, Reese PP, Hall IE, Jia Y, Yamamoto Y, Thiessen-Philbrook HR, Obeid W, Doshi MD, Akalin E, Bromberg JS, Harhay MN, Mohan S, Muthukumar T, Singh P, Weng FL, Moledina DG, Greenberg JH, Wilson FP, Parikh CR. Clinically adjudicated deceased donor acute kidney injury and graft outcomes. PLoS One 2022; 17:e0264329. [PMID: 35239694 PMCID: PMC8893682 DOI: 10.1371/journal.pone.0264329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) in deceased donors is not associated with graft failure (GF). We hypothesize that hemodynamic AKI (hAKI) comprises the majority of donor AKI and may explain this lack of association. METHODS In this ancillary analysis of the Deceased Donor Study, 428 donors with available charts were selected to identify those with and without AKI. AKI cases were classified as hAKI, intrinsic (iAKI), or mixed (mAKI) based on majority adjudication by three nephrologists. We evaluated the associations between AKI phenotypes and delayed graft function (DGF), 1-year eGFR and GF. We also evaluated differences in urine biomarkers among AKI phenotypes. RESULTS Of the 291 (68%) donors with AKI, 106 (36%) were adjudicated as hAKI, 84 (29%) as iAKI and 101 (35%) as mAKI. Of the 856 potential kidneys, 669 were transplanted with 32% developing DGF and 5% experiencing GF. Median 1-year eGFR was 53 (IQR: 41-70) ml/min/1.73m2. Compared to non-AKI, donors with iAKI had higher odds DGF [aOR (95%CI); 4.83 (2.29, 10.22)] and had lower 1-year eGFR [adjusted B coefficient (95% CI): -11 (-19, -3) mL/min/1.73 m2]. hAKI and mAKI were not associated with DGF or 1-year eGFR. Rates of GF were not different among AKI phenotypes and non-AKI. Urine biomarkers such as NGAL, LFABP, MCP-1, YKL-40, cystatin-C and albumin were higher in iAKI. CONCLUSION iAKI was associated with higher DGF and lower 1-year eGFR but not with GF. Clinically phenotyped donor AKI is biologically different based on biomarkers and may help inform decisions regarding organ utilization.
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Affiliation(s)
- Sherry G. Mansour
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT, United States of America
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, United States of America
| | - Nadeen Khoury
- Division of Nephrology, Henry Ford Health System, Detroit, MI, United States of America
| | - Ravi Kodali
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, United States of America
| | - Sarthak Virmani
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, United States of America
| | - Peter P. Reese
- Department of Medicine, Renal-Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Isaac E. Hall
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Yaqi Jia
- Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Yu Yamamoto
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT, United States of America
| | | | - Wassim Obeid
- Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Mona D. Doshi
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Enver Akalin
- Montefiore-Einstein Kidney Transplant program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Jonathan S. Bromberg
- Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Meera N. Harhay
- Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, PA, United States of America
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States of America
- Tower Health Transplant Institute, Tower Health System, West Reading, PA, United States of America
| | - Sumit Mohan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States of America
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America
| | - Thangamani Muthukumar
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, United States of America
- Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, United States of America
| | - Pooja Singh
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Francis L. Weng
- Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, NJ, United States of America
| | - Dennis G. Moledina
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT, United States of America
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, United States of America
| | - Jason H. Greenberg
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT, United States of America
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, United States of America
| | - Francis P. Wilson
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT, United States of America
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, United States of America
| | - Chirag R. Parikh
- Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
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Apel H, Rother U, Wach S, Schiffer M, Kunath F, Wullich B, Heller K. Transplant Ureteral Stenosis after Renal Transplantation: Risk Factor Analysis. Urol Int 2021; 106:518-526. [PMID: 34781290 DOI: 10.1159/000519787] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The results of kidney transplants have improved dramatically in recent years, leading to reduced morbidity and mortality. Despite continuous improvements, urological complications occur at a rate of 2.6%-15%. Ureteral stenosis of graft ureters is the most common complication, with a probability of 0.5%-6.3%. This study aimed to determine the incidence of ureteral stenosis after kidney transplantation and identify risk factors that distinguish transplant patients with and without ureteral stenosis. METHODS This study retrospectively analyzed patients who had undergone kidney transplantation at the Department of Urology of the Friedrich-Alexander University Erlangen-Nuremberg between 2001 and 2015. Forty-seven patients developed ureteral stenosis during the operation. Most of the ureteral stenosis cases occurred in the first 4 months after transplantation. Kaplan-Meier analysis and the log-rank test were used to calculate the cumulative risk, and the Mann-Whitney U test was used nonparametrically. The significance level was set at p < 0.05. RESULTS Statistical analysis showed that residual diuresis (p = 0.008), cold ischemia time (CIT) (p = 0.040), the body mass index (p = 0.027), and donor serum creatinine value (p = 0.039) showed a significantly different distribution between recipients with or without ureteral stenosis after kidney transplantation. In multivariate Cox's regression modeling, residual diuresis and the donor serum creatinine level were identified as the only independent predictors of patients' stenosis-free survival. CONCLUSION Urological complications not diagnosed and treated in time endanger the success of kidney transplantation. After evaluating the kidney transplantation data of the patients at the Transplant Center Erlangen-Nuremberg from 2001 to 2015, residual diuresis, CIT, the body mass index, and donor serum creatinine value were found to influence the development of ureteral stenosis.
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Affiliation(s)
- Hendrik Apel
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich Rother
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Surgery, Vascular Surgery Section, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Wach
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mario Schiffer
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Kunath
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Katharina Heller
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Sun Y, McCulloch CE, Marr KA, Huang CY. Recurrent Events Analysis With Data Collected at Informative Clinical Visits in Electronic Health Records. J Am Stat Assoc 2020; 116:594-604. [PMID: 34248232 DOI: 10.1080/01621459.2020.1801447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although increasingly used as a data resource for assembling cohorts, electronic health records (EHRs) pose many analytic challenges. In particular, a patient's health status influences when and what data are recorded, generating sampling bias in the collected data. In this paper, we consider recurrent event analysis using EHR data. Conventional regression methods for event risk analysis usually require the values of covariates to be observed throughout the follow-up period. In EHR databases, time-dependent covariates are intermittently measured during clinical visits, and the timing of these visits is informative in the sense that it depends on the disease course. Simple methods, such as the last-observation-carried-forward approach, can lead to biased estimation. On the other hand, complex joint models require additional assumptions on the covariate process and cannot be easily extended to handle multiple longitudinal predictors. By incorporating sampling weights derived from estimating the observation time process, we develop a novel estimation procedure based on inverse-rate-weighting and kernel-smoothing for the semiparametric proportional rate model of recurrent events. The proposed methods do not require model specifications for the covariate processes and can easily handle multiple time-dependent covariates. Our methods are applied to a kidney transplant study for illustration.
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Affiliation(s)
- Yifei Sun
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158.,Johns Hopkins University School of Medicine, Baltimore, MD 21205.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158
| | - Charles E McCulloch
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158.,Johns Hopkins University School of Medicine, Baltimore, MD 21205.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158
| | - Kieren A Marr
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158.,Johns Hopkins University School of Medicine, Baltimore, MD 21205.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158
| | - Chiung-Yu Huang
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158.,Johns Hopkins University School of Medicine, Baltimore, MD 21205.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158
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8
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Kim SM, Han A, Ahn S, Min SI, Min SK, Ha J. Klotho as a potential predictor of deceased donor kidney transplantation outcomes. Ann Surg Treat Res 2020; 98:332-339. [PMID: 32528913 PMCID: PMC7263887 DOI: 10.4174/astr.2020.98.6.332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/19/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Klotho is an antiaging factor mainly produced by renal tubular cells. Klotho is reportedly decreased in an animal model of acute kidney injury and patients with chronic kidney disease. However, information on Klotho expression after kidney transplantation is limited. We analyzed the correlation between donor Klotho expression and clinical outcomes of kidney transplantation. Methods Sixty patients who underwent deceased donor kidney transplantation between March 2015 and October 2017 were enrolled. Serum and tissue Klotho expression levels were measured by enzyme-linked immunosorbent assay and immunohistochemistry, respectively. Graft function was assessed by estimated glomerular filtration rate (eGFR). Results Patients were divided into 2 groups according to donor Klotho expression in renal tissues. A greater improvement in eGFR was observed at 1 week after transplantation in patients receiving kidneys with higher Klotho expression (47.5 ± 21.9 mL/min/1.73 m2vs. 63.9 ± 28.2 mL/min/1.73 m2, P = 0.030). Patients were also classified into 2 groups according to donor serum Klotho level. There was a tendency for a higher eGFR at 12 months after transplantation in patients receiving kidneys from donors with a higher Klotho level (51.0 ± 18.0 mL/min/1.73 m2vs. 61.2 ± 16.5 mL/min/1.73 m2, P = 0.059). When subgrouped into patients with or without biopsy-proven acute rejection, 12-month eGFR remained higher in patients receiving kidneys from donors with higher serum Klotho. Conclusion Our data demonstrated that donor tissue expression of Klotho correlated with early recovery of eGFR after kidney transplantation. Donor serum Klotho level tended to be associated with posttransplant 12-month eGFR. Donor Klotho expression might be a new predictor for deceased donor kidney transplantation outcome.
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Affiliation(s)
- Suh Min Kim
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Il Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Transplantation Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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9
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Collini A, Piccioni S, Lorenz EM, Borgogni V, Ruggieri G, Carmellini M. Long-Term Function of Kidneys From an Acute Renal Failure Donor on Continuous Venovenous Hemofiltration: A Case Report. Transplant Proc 2020; 52:1611-1616. [PMID: 32253001 DOI: 10.1016/j.transproceed.2020.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 10/24/2022]
Abstract
The organ shortage has induced many transplant centers to use suboptimal grafts, such as those from expanded criteria donors and donors after cardiac death. Acute renal failure donors, sometimes present in intensive therapy units, have been used in a very low number of cases due to the fear of primary nonfunction of this type of graft. There are few published studies about the utilization of donors with severe acute renal failure and there is no general consensus identifying unequivocal criteria for their use by different transplant centers. We transplanted 2 kidneys from a 67-year-old donor who suffered from acute renal failure as a consequence of extracorporeal circulation in cardiac surgery and died of a massive cerebral edema with cistern obliteration. The kidneys were discarded by other transplant centers due to the patient's acute renal failure, treated by continuous venovenous hemofiltration. Both transplants were successful and both grafts showed very good renal function after 6 months. One recipient suffered from delayed graft function and renal drug toxicity, which resolved 1 month post transplant. The long-term graft function at 10 years is acceptable, with very low proteinuria. As a growing gap between the inadequate supply and constantly high demand for kidney transplantation has led doctors to explore novel policies to increase the number of available organs over the last 2 decades, acute renal failure treated by continuous venovenous hemofiltration does not seem to be a contraindication for the utilization of grafts.
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Affiliation(s)
- Andrea Collini
- Renal Transplant Center, Siena University Hospital, Siena, Italy.
| | | | | | - Vanessa Borgogni
- Renal Transplant Center, Siena University Hospital, Siena, Italy
| | | | - Mario Carmellini
- Renal Transplant Center, Siena University Hospital, Siena, Italy
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10
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Bell R, Farid S, Pandanaboyana S, Upasani V, Baker R, Ahmad N. The evolution of donation after circulatory death renal transplantation: a decade of experience. Nephrol Dial Transplant 2019; 34:1788-1798. [PMID: 29955846 DOI: 10.1093/ndt/gfy160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/01/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study compared long-term outcomes of renal transplantation from donors following donation after circulatory death (DCD) with those following donation after brain death (DBD) from one of the largest centres in the UK. METHOD Recipients of renal transplants from deceased donors between 2002 and 2014 were identified from a prospectively maintained database. Outcomes were compared between DCD (468) and DBD (905) donors and between standard criteria donors (SCDs) and extended criteria donors (ECDs). RESULTS Graft survival (GS) and patient survival (PS) from DCD and DBD donors were comparable up to 10 years (GS: 61 versus 55%, P = 0.780; PS: 78 versus 71%, P = 0.285, respectively). Graft function was comparable after 3 months. GS and function were worse in the ECD groups, with no difference between EC-DBD and EC-DCD. PS in the ECD groups was worse than the SCD groups and PS in the EC-DCD group was worse than in the EC-DBD group. DCD donors were an independent risk factor for delayed graft function. Post-operative complications and EC-DCD donation were independent risk factors for reduced GS and PS. CONCLUSION This study supports the use of DCD renal grafts with comparable long-term survival and function to DBD grafts. The use of EC-DCD grafts is justified in selected recipients and provides acceptable function and survival advantages over dialysis.
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Affiliation(s)
- Richard Bell
- Department of Hepatobiliary and Transplant Surgery, Grafton, Auckland, New Zealand
| | - Shahid Farid
- Department of Hepatobiliary and Transplant Surgery, Grafton, Auckland, New Zealand
| | - Sanjay Pandanaboyana
- Department of Hepatobiliary and Transplant Surgery, Grafton, Auckland, New Zealand.,Department of Hepatopancreaticobiliary and Transplant Surgery, Grafton, Auckland, New Zealand
| | - Vivek Upasani
- Department of Hepatobiliary and Transplant Surgery, Grafton, Auckland, New Zealand
| | - Richard Baker
- Department of Nephrology, St James University Hospital, Leeds, UK
| | - Niaz Ahmad
- Department of Hepatobiliary and Transplant Surgery, Grafton, Auckland, New Zealand
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11
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Long-term Outcomes Following Kidney Transplantation From Donors With Acute Kidney Injury. Transplantation 2019; 103:e263-e272. [DOI: 10.1097/tp.0000000000002792] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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12
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Sanders JM, Opdam HI, Furniss H, Hughes PD, Kanellis J, Jones D. Frequency and outcomes of kidney donation from intensive care patients with acute renal failure requiring renal replacement therapy. Nephrology (Carlton) 2019; 24:1296-1303. [PMID: 31081209 DOI: 10.1111/nep.13601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Kidney transplantation is the preferred treatment for end-stage renal failure. Unfortunately, donor organ shortages prevent many individuals receiving a renal transplant and there is a need to increase the pool of appropriate donors. The presence of acute kidney injury (AKI) in deceased donors has traditionally been a relative contraindication to renal transplantation, even though renal recovery may be favorable in the absence of chronic renal disease. METHODS We undertook an 8 years retrospective observational study of potential deceased organ donors with AKI requiring renal replacement therapy (RRT). We evaluated the rate of successful transplantation as well as short term and outcomes at a median of 19.5 (13.0-52.7) months after donation. RESULTS Amongst 1058 consented potential organ donors, 39 patients had AKI requiring RRT, of which 19 became donors (13 not medically suitable, 7 did not proceed to donation). The median (interquartile range (IQR)) donor age was 41 (34-50) years and norepinephrine, epinephrine and vasopressin were given to 18, 14 and 9 donors, respectively. From the 38 donated kidneys 34 were transplanted. The median (IQR) age of recipients was 53 (42.8-58.5) years and they were dialysis free in a median (IQR) of 5.5 (2.3-10.8) days. Only minor abnormalities were found at 3 and 6 months renal biopsies, and two patients experienced graft failure in the first 12 months. CONCLUSION Amongst deceased donors with AKI receiving RRT and vasoactive medications outcomes of renal transplantation seems acceptable in the absence of pre-existing renal failure and other donor co-morbidity. Such patients may be an important additional source of kidney donation.
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Affiliation(s)
- Jo M Sanders
- DonateLife Victoria, Carlton, Victoria, Australia
| | - Helen I Opdam
- Austin Health, Heidelberg, Victoria, Australia.,Organ and Tissue Authority Canberra, Canberra, Canberra ACT, Australia
| | | | - Peter D Hughes
- Department of Nephrology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine (RMH), Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health and Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Monash Health and Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria, Australia
| | - Daryl Jones
- Austin Health, Heidelberg, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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13
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Orlando G, Khan MA, El-Hennawy H, Farney AC, Rogers J, Reeves-Daniel A, Gautreaux MD, Doares W, Kaczmorski S, Stratta RJ. Is prolonged cold ischemia a contraindication to using kidneys from acute kidney injury donors? Clin Transplant 2018; 32:e13185. [PMID: 29285808 DOI: 10.1111/ctr.13185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 11/27/2022]
Abstract
To determine the impact of prolonged cold ischemia time (CIT) on the outcome of acute kidney injury (AKI) renal grafts, we therefore performed a single-center retrospective analysis in adult patients receiving kidney transplantation (KT) from AKI donors. Outcomes were stratified according to duration of CIT. A total of 118 patients receiving AKI grafts were enrolled. Based on CIT, patients were stratified as follows: (i) <20 hours, 27 patients; (ii) 20-30 hours, 52 patients; (iii) 30-40 hours, 30 patients; (iv) ≥40 hours, nine patients. The overall incidence of delayed graft function DGF was 41.5%. According to increasing CIT category, DGF rates were 30%, 42%, 40%, and 78%, respectively (P = .03). With a mean follow-up of 48 months, overall patient and graft survival rates were 91% and 81%. Death-censored graft survival (DCGS) rates were 84% and 88% for patients with and without DGF (P = NS). DCGS rates were 92% in patients with CIT <20 hours compared to 85% with CIT >20 hours (P = NS). In the nine patients with CIT >40 hours, the 4-year DCGS rate was 100%. We conclude that prolonged CIT in AKI grafts may not adversely influence outcomes and so discard of AKI kidneys because of projected long CIT is not warranted when donors are wisely triaged.
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Affiliation(s)
- Giuseppe Orlando
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Muhammad A Khan
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hany El-Hennawy
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alan C Farney
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeffrey Rogers
- Department of Surgery, Section of Transplantation, 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
| | - Michael D Gautreaux
- Section of Nephrology, Pathology, 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
| | - Robert J Stratta
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Si Nga H, Takase H, Bravin A, Garcia P, Contti M, Kojima C, de Andrade L. Good Outcomes in Kidney Transplantation With Deceased Donor With Acute Kidney Injury: Donor's Age and Not Acute Kidney Injury Predicts Graft Function. Transplant Proc 2016; 48:2262-2266. [DOI: 10.1016/j.transproceed.2016.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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15
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Outcomes of Kidney Transplantation from Circulatory Death Donors With Increased Terminal Creatinine Levels in Serum. Transplantation 2016; 100:1532-40. [DOI: 10.1097/tp.0000000000000955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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16
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Kidney transplantation from deceased donors with elevated serum creatinine. Langenbecks Arch Surg 2016; 401:1211-1217. [DOI: 10.1007/s00423-016-1445-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
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17
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Young A, Dixon SN, Knoll GA, Garg AX, Lok CE, Lam NN, Kim SJ. The Canadian experience using the expanded criteria donor classification for allocating deceased donor kidneys for transplantation. Can J Kidney Health Dis 2016; 3:15. [PMID: 27014467 PMCID: PMC4806479 DOI: 10.1186/s40697-016-0106-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/07/2016] [Indexed: 11/13/2022] Open
Abstract
Background Although the outcomes of transplantation with expanded criteria donor (ECD) kidneys are inferior to non-ECD transplants in the USA, the impact of the ECD classification on Canadian kidney transplant recipients is not known. Objectives The objective of the study was to assess the performance of the US-derived ECD classification among deceased donor kidney transplant recipients in a Canadian setting. Design This study was a population-based cohort study. Setting The study was conducted in all adult kidney transplant centers in the province of Ontario. Patients The patients were incident-deceased donor kidney transplant recipients from January 1, 2005 to March 31, 2011. Measurements Study subjects were identified through the Trillium Gift of Life Network and linked to healthcare databases in Ontario. ECD status was based on age, hypertension, kidney function, and stroke-related death. Outcomes of interest included graft loss, death, and delayed graft function. Methods The Kaplan-Meier product limit method was used to graphically assess time to graft loss or death. Multivariable Cox proportional hazards models were used to assess graft loss or death as a function of ECD status. Multivariable logistic regression models were fitted for the outcome of delayed graft function. Results Of 1422 deceased donor kidney transplants, 325 (23 %) were from ECDs. The median donor age was 63 vs. 42 years for ECD vs. non-ECD, respectively. The 5-year cumulative incidence of total graft loss was 29.2 % in ECD and 20.7 % in non-ECD kidney transplants. The relative hazards for total graft loss (HR 1.48 [95 % CI, 1.10; 2.00]) and death-censored graft loss (HR 1.80 [95 % CI, 1.19, 2.71]) were increased in ECD vs. non-ECD transplants. Increased relative risks were also observed for death and delayed graft function, albeit not statistically significant. Limitations Although comprehensive in coverage and outcome ascertainment, the available details on covariate data may be limited in large healthcare databases. Conclusions The ECD classification identifies kidneys at increased risk for graft loss in Canadian patients. The performance of more granular measures of donor risk (e.g., Kidney Donor Risk Index) and its impact on organ allocation/utilization in Canadian patients requires further study. Electronic supplementary material The online version of this article (doi:10.1186/s40697-016-0106-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ann Young
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
| | | | - Greg A Knoll
- Institute for Clinical Evaluative Sciences, Ontario, Canada ; Division of Nephrology, University of Ottawa, Ottawa, Ontario Canada
| | - Amit X Garg
- Institute for Clinical Evaluative Sciences, Ontario, Canada ; Division of Nephrology, Western University, London, Ontario Canada
| | - Charmaine E Lok
- Department of Medicine, University of Toronto, Toronto, Ontario Canada ; Institute for Clinical Evaluative Sciences, Ontario, Canada ; Division of Nephrology, Toronto General Hospital, University Health Network, University of 585 University Avenue, 11-PMB-129 Toronto, Ontario Canada
| | - Ngan N Lam
- Division of Nephrology, University of Alberta, Edmonton, Alberta Canada
| | - S Joseph Kim
- Department of Medicine, University of Toronto, Toronto, Ontario Canada ; Institute for Clinical Evaluative Sciences, Ontario, Canada ; Division of Nephrology, Toronto General Hospital, University Health Network, University of 585 University Avenue, 11-PMB-129 Toronto, Ontario Canada
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18
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Chaudhuri A, Gallo A, Grimm P. Pediatric deceased donor renal transplantation: An approach to decision making II. Acceptability of a deceased donor kidney for a child, a snap decision at 3 AM. Pediatr Transplant 2015; 19:785-91. [PMID: 26426405 DOI: 10.1111/petr.12582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 11/30/2022]
Abstract
Allocation of deceased donor kidneys is based on several criteria; however, the final decision to accept or reject the offered kidney is made by the potential recipient's transplant team (surgeon/nephrologist). Several considerations including assessment of the donor quality, the HLA match between the donor and the recipient, several recipient factors, the geographical location of the recipient, and the organ all affect the decision of whether or not to finally accept the organ for a particular recipient. This decision needs to be made quickly, often on the spot. Maximizing the benefit from this scarce resource raises difficult ethical issues. The philosophies of equity and utility are often competing. This article will discuss the several considerations for the pediatric nephrologist while accepting a deceased donor kidney for a particular pediatric patient.
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Affiliation(s)
- Abanti Chaudhuri
- Department of Pediatric Nephrology, Stanford University, Stanford, CA, USA
| | - Amy Gallo
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Paul Grimm
- Department of Pediatric Nephrology, Stanford University, Stanford, CA, USA
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19
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Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case-control study. Int Urol Nephrol 2015; 47:2039-46. [PMID: 26498631 DOI: 10.1007/s11255-015-1127-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/24/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Whether organs from donors after brain death (DBD) with acute kidney injury (AKI) should be accepted for transplantation is still a matter of debate. METHODS This was a retrospective, center-based, matched cohort study of 33 renal transplant patients who received a renal allograft from a DBD with AKI. Sixty-five kidney transplants without donor AKI transplanted directly before and after the index transplantation served as controls. RESULTS All AKI donors were classified according to RIFLE criteria: 9.1 % Risk, 54.6 % Injury, and 36.4 % Failure. Mean serum creatinine was 2.41 ± 0.88 mg/dL at procurement and 1.06 ± 0.32 mg/dL on admission. AKI donors had lower 24-h urine production (3.22 ± 1.95 vs. 4.59 ± 2.53 L, p = 0.009) and received more frequently noradrenaline (93.9 vs. 72.3 %, p = 0.02) and/or adrenaline (15.2 vs. 1.5 %, p = 0.02). Recipient and transplant characteristics were similar except a more favorable HLA match in control patients (p = 0.01). Hemodialysis posttransplant was more frequently used in AKI recipients (14/33 [42.4 %] vs. 18/65 [27.7 %], p = 0.17). While significant elevations in serum creatinine were noted in these patients until 10 days after transplantation, this difference lost statistical significance by day 14. One-year graft survival was very similar when comparing the groups (93.6 % [95 % CI 76.8-98.4 %] vs. 90.3 % [95 % CI 79.6-95.5 %], log rank p = 0.58). CONCLUSIONS Kidneys from AKI donors can be transplanted with excellent intermediate prognosis and should not be discarded.
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20
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Matos ACCD, Requião-Moura LR, Clarizia G, Durão Junior MDS, Tonato EJ, Chinen R, Arruda ÉFD, Filiponi TC, Pires LMDMB, Bertocchi APF, Pacheco-Silva A. Expanding the pool of kidney donors: use of kidneys with acute renal dysfunction. EINSTEIN-SAO PAULO 2015; 13:319-25. [PMID: 26154553 PMCID: PMC4943830 DOI: 10.1590/s1679-45082015rw3147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 02/08/2015] [Indexed: 02/05/2023] Open
Abstract
Given the shortage of organs transplantation, some strategies have been adopted by the transplant community to increase the supply of organs. One strategy is the use of expanded criteria for donors, that is, donors aged >60 years or 50 and 59 years, and meeting two or more of the following criteria: history of hypertension, terminal serum creatinine >1.5mg/dL, and stroke as the donor´s cause of death. In this review, emphasis was placed on the use of donors with acute renal failure, a condition considered by many as a contraindication for organ acceptance and therefore one of the main causes for kidney discard. Since these are well-selected donors and with no chronic diseases, such as hypertension, renal disease, or diabetes, many studies showed that the use of donors with acute renal failure should be encouraged, because, in general, acute renal dysfunction is reversible. Although most studies demonstrated these grafts have more delayed function, the results of graft and patient survival after transplant are very similar to those with the use of standard donors. Clinical and morphological findings of donors, the use of machine perfusion, and analysis of its parameters, especially intrarenal resistance, are important tools to support decision-making when considering the supply of organs with renal dysfunction.
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Affiliation(s)
| | | | - Gabriela Clarizia
- Instituto Israelita de Responsabilidade Social, São Paulo, SP, Brazil
| | | | | | - Rogério Chinen
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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21
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Ali T, Dimassi W, Elgamal H, Alabassi A, Aleid H, Altalhi M, Shoukri M, Almeshari K. Outcomes of kidneys utilized from deceased donors with severe acute kidney injury. QJM 2015; 108:803-11. [PMID: 25660604 DOI: 10.1093/qjmed/hcv033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Significant numbers of kidneys are discarded due to raised terminal creatinine of the donor. AIM To determine long-term outcomes of kidneys utilized from donors with severe acute kidney injury (AKI). METHODS In this retrospective study, we included all patients who received kidneys from deceased donors between years 2000 and 2012. AKI was defined according to the acute kidney injury network (AKIN) classification. The primary outcomes were patient and graft survival and secondary outcomes were renal function at different time points, delayed graft function, acute rejection and length of hospital stay. RESULTS Two hundred and eighty-four recipients received kidneys from 261 deceased donors. One hundred and fourteen patients (40%) received kidneys from the donors with AKI. Forty-two patients received kidneys from the donors with severe AKI (AKIN-3 category). Mean age of the donor and recipient was 36 and 37 years, respectively. Main cause of death in donors was road traffic accident (34%) followed by cerebrovascular accident (33%). Terminal creatinine was 85 and 262 μmol/l in non-AKI and AKI groups, respectively (P < 0.001). Significantly more patients in the AKI group had delayed graft function (P = 0.006), prolonged hospital stay (P < 0.001) and high creatinine at discharge (P = 0.002). However, acute rejection rates (P = 0.25), 1-, 5- and 10-year graft survival (P = 0.57) and patient survival (P = 0.77) were not different between AKI and non-AKI groups. The outcomes in the AKIN-3 category were comparable with the non-AKI group. CONCLUSIONS This study has shown favorable long-term outcomes of kidneys utilized from donors with severe AKI. This study may encourage healthcare professionals to consider accepting such kidneys.
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Affiliation(s)
- T Ali
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - W Dimassi
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - H Elgamal
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - A Alabassi
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - H Aleid
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - M Altalhi
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - M Shoukri
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - K Almeshari
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
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Lee JY, Kim YH, Kwon HW, Choi JY, Shin S, Jung JH, Hong JJ, Han DJ. Kidney Transplantation from the Deceased Donor Who Need Continuous Renal Replace Therapy. KOREAN JOURNAL OF TRANSPLANTATION 2015. [DOI: 10.4285/jkstn.2015.29.4.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ju Yeon Lee
- Division of Kidney and Pancreatic Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hoon Kim
- Division of Kidney and Pancreatic Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Wook Kwon
- Division of Kidney and Pancreatic Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yoon Choi
- Division of Kidney and Pancreatic Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Shin
- Division of Kidney and Pancreatic Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hee Jung
- Division of Kidney and Pancreatic Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Ja Hong
- Organ Transplant Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duck Jong Han
- Division of Kidney and Pancreatic Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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23
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Chaudhuri A, James G, Grimm P. Whether or not to accept a deceased donor kidney offer for a pediatric patient. Pediatr Nephrol 2015; 30:1529-36. [PMID: 26130248 DOI: 10.1007/s00467-015-3139-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/22/2015] [Accepted: 05/27/2015] [Indexed: 12/01/2022]
Abstract
The expansion of the number of children on the deceased donor renal transplant waitlist has far outstripped the supply of organs in most countries, leading to numerous adjustments to increase supply and to maximize the utility of donor organs. The system for organ allocation varies by country based on local laws, priorities, and resources. Adjustments are made to optimize allocation, enhance post-transplant survival benefit, decrease unequal transplant access, and optimize utilization of donated kidneys. Allocation of deceased donor kidneys is based on several criteria; however, the final decision to accept or reject the offered kidney is made by the potential recipient's transplant team (surgeon/nephrologist). Several considerations including assessment of the donor quality, the human leukocyte antigen (HLA) match between the donor and the recipient, numerous recipient factors, the geographical location of the recipient, and the organ all affect the decision to accept the organ or not for a particular recipient. This decision must be made quickly, often on the spot. Maximizing the benefit from this scarce resource raises difficult ethical issues. The philosophies of equity and utility are often competing. In this manuscript, we highlight a representative case that helps to focus on important issues for the pediatric nephrologist to consider while making the decision to accept a deceased donor kidney offer for a particular pediatric patient.
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Affiliation(s)
- Abanti Chaudhuri
- Department of Pediatric Nephrology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305-5208, USA,
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24
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Heilman RL, Smith ML, Kurian SM, Huskey J, Batra RK, Chakkera HA, Katariya NN, Khamash H, Moss A, Salomon DR, Reddy KS. Transplanting Kidneys from Deceased Donors With Severe Acute Kidney Injury. Am J Transplant 2015; 15:2143-51. [PMID: 25808278 DOI: 10.1111/ajt.13260] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 01/21/2015] [Accepted: 02/05/2015] [Indexed: 01/25/2023]
Abstract
Our aim was to determine outcomes with transplanting kidneys from deceased donors with acute kidney injury, defined as a donor with terminal serum creatinine ≥2.0 mg/dL, or a donor requiring acute renal replacement therapy. We included all patients who received deceased donor kidney transplant from June 2004 to October 2013. There were 162 AKI donor transplant recipients (21% of deceased donor transplants): 139 in the standard criteria donor (SCD) and 23 in the expanded criteria donor (ECD) cohort. 71% of the AKI donors had stage 3 (severe AKI), based on acute kidney injury network (AKIN) staging. Protocol biopsies were done at 1, 4, and 12 months posttransplant. One and four month formalin-fixed paraffin embedded (FFPE) biopsies from 48 patients (24 AKI donors, 24 non-AKI) underwent global gene expression profiling using DNA microarrays (96 arrays). DGF was more common in the AKI group but eGFR, graft survival at 1 year and proportion with IF/TA>2 at 1 year were similar for the two groups. At 1 month, there were 898 differentially expressed genes in the AKI group (p-value <0.005; FDR <10%), but by 4 months there were no differences. Transplanting selected kidneys from deceased donors with AKI is safe and has excellent outcomes.
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Affiliation(s)
- R L Heilman
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - M L Smith
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - S M Kurian
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA
| | - J Huskey
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - R K Batra
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - H A Chakkera
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | | | - H Khamash
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - A Moss
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - D R Salomon
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA
| | - K S Reddy
- Department of Surgery, Mayo Clinic, Phoenix, AZ
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Xia Y, Friedmann P, Cortes CM, Lubetzky ML, Kayler LK. Influence of Cold Ischemia Time in Combination with Donor Acute Kidney Injury on Kidney Transplantation Outcomes. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kidney transplantation from cardiac death donors with terminal acute renal failure. Transplant Proc 2015; 46:1057-60. [PMID: 24815127 DOI: 10.1016/j.transproceed.2013.11.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/18/2013] [Accepted: 11/22/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Kidney transplantation from donation after cardiac death (DCD) donors with terminal acute renal failure (ARF) is not widely accepted due to concern about the organ quality. Here we report our initial clinical outcomes of kidney transplantation from DCD donors with ARF. MATERIALS AND METHODS The results of 29 kidney transplants from ARF DCD donors were compared with those of 60 kidney transplants from non-ARF DCD donors performed at our center from August 2011 to March 2013. RESULTS There was no difference in the incidence of delayed graft function and acute rejection between ARF and non-ARF kidneys (27.6% vs 16.7%, 10.3% vs 8.3%, respectively). Estimated glomerular filtration rate at 12 months was similar between ARF and non-ARF kidneys. With a mean follow-up of 18 months (range 7 to 26 months), actual patient and graft survival rates for ARF DCD recipients were 100% and 96.6%, respectively, which were similar to those of the control group of kidney transplants from non-ARF kidneys (98.3% and 95.0%). CONCLUSIONS Kidneys from DCD donors with terminal ARF have excellent short-term outcomes and may represent another potential method to safely expand the donor pool.
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Lee MH, Jeong EG, Chang JY, Kim Y, Kim JI, Moon IS, Choi BS, Park CW, Yang CW, Kim YS, Chung BH. Clinical outcome of kidney transplantation from deceased donors with acute kidney injury by Acute Kidney Injury Network criteria. J Crit Care 2014; 29:432-7. [DOI: 10.1016/j.jcrc.2013.12.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 11/24/2013] [Accepted: 12/24/2013] [Indexed: 12/11/2022]
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Marshall GR, Mangus RS, Powelson JA, Fridell JA, Kubal CA, Tector AJ. Donor management parameters and organ yield: single center results. J Surg Res 2014; 191:208-13. [PMID: 24953985 DOI: 10.1016/j.jss.2014.02.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/17/2014] [Accepted: 02/27/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Management of organ donors in the intensive care unit is an emerging subject in critical care and transplantation. This study evaluates organ yield outcomes for a large number of patients managed by the Indiana Organ Procurement Organization. MATERIALS AND METHODS This is a retrospective review of intensive care unit records from 2008-2012. Donor demographic information and seven donor management parameters (DMP) were recorded at admission, consent, 12 h after consent, and before procurement. Three study groups were created: donors meeting 0-3, 4, or 5-7 DMP. Active donor Organ Procurement Organization management began at consent; so, data analysis focuses on the 12-h postconsent time point. Outcomes included organs transplanted per donor (OTPD) and transplantation of individual solid organs. RESULTS Complete records for 499 patients were reviewed. Organ yield was 1415 organs of 3992 possible (35%). At 12 h, donors meeting more DMP had more OTPD: 2.2 (0-3) versus 3.0 (4) versus 3.5 (5-7) (P < 0.01). Aggregate DMP met was significantly associated with transplantation of every organ except intestine. Oxygen tension, vasopressor use, and central venous pressure were the most frequent independent predictors of organ usage. There were significantly more organs transplanted for donors meeting all three of these parameters (4.5 versus 2.7, P < 0.01). CONCLUSIONS Initial DMP met does not appear to be a significant prognostic factor for OTPD. Aggregate DMP is associated with transplantation rates for most organs, with analysis of individual parameters suggesting that appropriate management of oxygenation, volume status, and vasopressor use could lead to more organs procured per donor.
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Affiliation(s)
- George Ryne Marshall
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Richard S Mangus
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
| | - John A Powelson
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jonathan A Fridell
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Chandrashekhar A Kubal
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - A Joseph Tector
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Hwang J, Park S, Kwon K, Choi B, Kim J, Yang C, Kim Y, Moon I. Long-Term Outcomes of Kidney Transplantation From Expanded Criteria Deceased Donors at a Single Center: Comparison With Standard Criteria Deceased Donors. Transplant Proc 2014; 46:431-6. [DOI: 10.1016/j.transproceed.2013.11.061] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/22/2013] [Indexed: 02/02/2023]
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Hall IE, Reese PP, Weng FL, Schröppel B, Doshi MD, Hasz RD, Reitsma W, Goldstein MJ, Hong K, Parikh CR. Preimplant histologic acute tubular necrosis and allograft outcomes. Clin J Am Soc Nephrol 2014; 9:573-82. [PMID: 24558049 PMCID: PMC3944773 DOI: 10.2215/cjn.08270813] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/04/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The influence of deceased-donor AKI on post-transplant outcomes is poorly understood. The few published studies about deceased-donor preimplant biopsy have reported conflicting results regarding associations between AKI and recipient outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This multicenter study aimed to evaluate associations between deceased-donor biopsy reports of acute tubular necrosis (ATN) and delayed graft function (DGF), and secondarily for death-censored graft failure, first adjusting for the kidney donor risk index and then stratifying by donation after cardiac death (DCD) status. RESULTS Between March 2010 and April 2012, 651 kidneys (369 donors, 4 organ procurement organizations) were biopsied and subsequently transplanted, with ATN reported in 110 (17%). There were 262 recipients (40%) who experienced DGF and 38 (6%) who experienced graft failure. DGF occurred in 45% of kidneys with reported ATN compared with 39% without ATN (P=0.31) resulting in a relative risk (RR) of 1.13 (95% confidence interval [95% CI], 0.9 to 1.43) and a kidney donor risk index-adjusted RR of 1.11 (95% CI, 0.88 to 1.41). There was no significant difference in graft failure for kidneys with versus without ATN (8% versus 5%). In stratified analyses, the adjusted RR for DGF with ATN was 0.97 (95% CI, 0.7 to 1.34) for non-DCD kidneys and 1.59 (95% CI, 1.23 to 2.06) for DCD kidneys (P=0.02 for the interaction between ATN and DCD on the development of DGF). CONCLUSIONS Despite a modest association with DGF for DCD kidneys, this study reveals no significant associations overall between preimplant biopsy-reported ATN and the outcomes of DGF or graft failure. The potential benefit of more rigorous ATN reporting is unclear, but these findings provide little evidence to suggest that current ATN reports are useful for predicting graft outcomes or deciding to accept or reject allograft offers.
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Affiliation(s)
- Isaac E. Hall
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | | | - Rick D. Hasz
- Gift of Life Institute, Philadelphia, Pennsylvania
| | | | - Michael J. Goldstein
- Mount Sinai School of Medicine and New York Organ Donor Network, New York, New York; and
| | - Kwangik Hong
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Chirag R. Parikh
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Veterans Affairs Medical Center, West Haven, Connecticut
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Clinical Outcomes in Kidney Transplantation Patients From Deceased Donors With Acute Kidney Injury. Transplant Proc 2013; 45:2941-5. [DOI: 10.1016/j.transproceed.2013.08.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Transplantation With Kidneys Retrieved From Deceased Donors With Acute Renal Failure. Transplantation 2013; 95:611-6. [DOI: 10.1097/tp.0b013e318279153c] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Farney AC, Rogers J, Orlando G, al-Geizawi S, Buckley M, Farooq U, al-Shraideh Y, Stratta RJ. Evolving experience using kidneys from deceased donors with terminal acute kidney injury. J Am Coll Surg 2013; 216:645-55; discussion 655-6. [PMID: 23395159 DOI: 10.1016/j.jamcollsurg.2012.12.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 12/11/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kidney transplantation from deceased donors with terminal acute kidney injury (AKI) is not widely accepted. STUDY DESIGN Acute kidney injury donor kidneys were defined by a doubling of the donor's admission serum creatinine (SCr) level and a terminal SCr level >2.0 mg/dL before organ recovery. RESULTS Over 5.5 years, we transplanted 84 AKI donor kidneys, including 64 kidneys from standard criteria donors (SCD), 11 from expanded criteria donors (ECD), and 9 from donation after cardiac death (DCD) donors. Mean donor age was 36 years (range 15 to 68 years); mean admission and terminal donor SCr levels were 1.25 mg/dL and 3.2 mg/dL, respectively (mean terminal estimated glomerular filtration rate 25.5 mL/minute). With a mean follow-up of 35 months (range 6 to 70 months), actual patient and graft survival rates are 98% and 89%, respectively, which are numerically, but not statistically, higher than concurrent kidney transplants from brain-dead (non-AKI) SCDs at our center. Delayed graft function (DGF) occurred in 34 patients (40%). Mean 1-, 12-, and 24-month SCr levels were 1.8, 1.6, and 1.7 mg/dL, respectively. Delayed graft function was associated with lower 3-year graft survival for non-AKI SCD transplants (68% vs 90%, with and without DGF), but there was no impact of DGF on graft survival for AKI donor kidneys (89% vs 91%). CONCLUSIONS Although AKI donor kidneys more commonly have DGF, the higher rate of DGF does not worsen graft outcomes. Kidneys from deceased donors with terminal AKI transplanted into appropriately selected patients have excellent medium-term outcomes and represent a method to safely expand the donor pool.
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Affiliation(s)
- Alan C Farney
- Department of General Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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Bacak-Kocman I, Peric M, Kastelan Z, Kes P, Mesar I, Basic-Jukic N. First documented case of successful kidney transplantation from a donor with acute renal failure treated with dialysis. Int Urol Nephrol 2012; 45:1523-6. [DOI: 10.1007/s11255-012-0234-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 06/13/2012] [Indexed: 11/28/2022]
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Successful Kidney Transplantation from a Cadaveric Donor Unsuitable for Other Centers Due to Acute Renal Failure: A Case Report. Transplant Proc 2012; 44:1764-6. [DOI: 10.1016/j.transproceed.2012.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kim J, Kim S, Joh JW, Kwon C, Song S, Shin M, Kim B, Lee SK. Is It Safe to Use a Kidney From an Expanded Criteria Donor? Transplant Proc 2011; 43:2359-62. [DOI: 10.1016/j.transproceed.2011.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Deroure B, Kamar N, Depreneuf H, Jacquet A, Francois H, Charpentier B, Rostaing L, Durrbach A. Expanding the criteria of renal kidneys for transplantation: use of donors with acute renal failure. Nephrol Dial Transplant 2010; 25:1980-6. [PMID: 20167568 DOI: 10.1093/ndt/gfq009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increased numbers of patients waiting for renal transplantation have led to widening selection criteria for grafts. Thus, we have evaluated the outcome of transplanted kidneys procured in the presence of acute renal failure (ARF). METHODS Transplant patients (n = 52) with a kidney procured with ARF were studied. Clinical data from donors and recipients, serum creatinine (SCr), creatinine clearance [estimated glomerular filtration rate (eGFR)], cold ischaemia duration, time to urine flow recovery or renal function recovery, and the number of haemodialysis sessions, were collected retrospectively. RESULTS Mean donor age was 45.7 +/- 12.7 years, and the mean SCr at the time of harvesting was 276.3 +/- 104.2 micromol/l. Recipients' mean age was 51.1 +/- 12.1 years. After transplantation, recovery of renal function was observed after 7.6 +/- 7.1 days, and required 1.9 +/- 3.0 haemodialysis sessions. SCr was 124.6 +/- 49.5 micromol/l, and eGFR was 56.2 +/- 19.8 ml/min at last follow-up. eGFR was significantly lower if the donor's death was due to stroke or cerebral haemorrhage (CH), or if the donors had previous cardiovascular disease (CVD) (P < 0.02). Patients with eGFR of <50 ml/min (n = 23) had donors who were older, and whose cause of death was more frequently related to CVD factors or to CH/stroke (P < 0.03). There were no significant differences between the two groups regarding age of recipient, gender of the donor or recipient, cold ischaemia time, occurrence of cardiac arrest, collapse or acute rejection. Linear regression analysis indicated that donor age and occurrence of acute rejection were independent factors associated with eGFR. CONCLUSIONS ARF before organ procurement does not have a negative effect on subsequent renal function. However, old age, CVD risk factors or CH, and late renal function recovery after transplantation are correlated with subsequent lower renal function. Thus, renal grafts with ARF can be used for renal transplantations.
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Affiliation(s)
- Benjamin Deroure
- Department of Nephrology, Dialysis and Transplantation, Le Kremlin Bicetre, University Paris XI, APHP, France
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Abstract
INTRODUCTION With the worldwide shortage of donors, extra lengths are ongoing to enlarge the donor pool. One means has been a greater use of "expanded criteria donor" (ECD) grafts. A major concern regarding ECD kidneys is poor long-term graft survival. The aims of this study were to determine whether ECD grafts, as defined by the United Network for Organ Sharing, had a negative impact on graft survival and to identify the principle donor and recipient factors that influenced graft survival in our patient cohort. METHODS We analyzed all deceased donor renal transplants in our unit from January 1995 to October 2005, in total 1,053 transplants. RESULTS ECD grafts (United Network for Organ Sharing criteria) demonstrated higher rates of delayed graft function and higher early mean creatinine levels. However, there was no significant difference in 5-year graft survival. Multivariate analysis of our patient group identified donor hypertension and ischemic heart disease (IHD) as independent predictors of poor graft survival. Recipient age was significant on univariate but not on multivariate analysis. However, although younger recipients maintained acceptable 5-year graft survival despite donor hypertension, IHD, or a combination of both, these factors significantly reduced graft survival in older recipients. CONCLUSION Although ECD grafts had slightly worse function, 5-year survival was comparable with standard grafts in all recipients. Donor hypertension, IHD, or a combination of both significantly reduced graft survival in older recipients, not evident in younger patients. We discuss the possible factors for improved outcome with ECD grafts in our patients and the implications of our patient analysis.
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Rodrigo E, Minambres E, Pinera C, Llorca J, Fernandez-Fresnedo G, Vallejo A, Ruiz J, Ruiz J, Gago M, Arias M. Using RIFLE criteria to evaluate acute kidney injury in brain-deceased kidney donors. Nephrol Dial Transplant 2009; 25:1531-7. [DOI: 10.1093/ndt/gfp622] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zuckerman JM, Singh RP, Farney AC, Rogers J, Stratta RJ. Single center experience transplanting kidneys from deceased donors with terminal acute renal failure. Surgery 2009; 146:686-94; discussion 694-5. [DOI: 10.1016/j.surg.2009.06.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 06/05/2009] [Indexed: 11/26/2022]
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Zuckerman JM, Singh RP, Farney AC, Rogers J, Hines MH, Stratta RJ. Successful kidney transplantation from a donation after cardiac death donor with acute renal failure and bowel infarction using extracorporeal support. Transpl Int 2009; 22:798-804. [DOI: 10.1111/j.1432-2277.2009.00860.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kayler LK, Garzon P, Magliocca J, Fujita S, Kim RD, Hemming AW, Howard R, Schold JD. Outcomes and utilization of kidneys from deceased donors with acute kidney injury. Am J Transplant 2009; 9:367-73. [PMID: 19178415 DOI: 10.1111/j.1600-6143.2008.02505.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Utilization and long-term outcomes of kidneys from donors with elevated terminal serum creatinine (sCr) levels have not been reported. Using data from the Scientific Registry of Transplant Recipients from 1995 to 2007, recipient outcomes of kidneys from adult donors were evaluated stratified by standard criteria (SCD; n = 82 262) and expanded criteria (ECD; n = 16 978) donor type and by sCr </=1.5, 1.6-2.0 and >2.0 mg/dL. Discard rates for SCDs were ascertained. The relative risk of graft loss was similar for recipients of SCD kidneys with sCr of 1.6-2.0 and >2.0 mg/dL, compared to </=1.5 mg/dL. For ECD recipients, the relative risk of graft failure significantly increased with increasing sCr. Of potential SCDs, the adjusted risk of discard was higher with sCr >2.0 mg/dL (adjusted odds ratio [AOR] 7.04, 95% confidence interval [CI] 6.5-7.6) and 1.6-2.0 mg/dL (AOR 2.7; CI 2.5-2.9) relative to sCr </=1.5 mg/dL. Among potential SCDs, elevated terminal creatinine is a strong independent risk factor for kidney discard; yet, when kidney transplantation is performed elevated donor terminal creatinine is not a risk factor for graft loss. Further research is needed to identify safe practices for the optimal utilization of SCD kidneys from donors with acute kidney injury.
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Affiliation(s)
- L K Kayler
- Shands Hospital at the University of Florida, Gainesville, FL, USA.
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Greenstein SM, Moore N, McDonough P, Schechner R, Tellis V. Excellent outcome using “impaired” standard criteria donors with elevated serum creatinine. Clin Transplant 2008; 22:630-3. [DOI: 10.1111/j.1399-0012.2008.00835.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Parental Donors in Live-Donor Kidney Transplantation Associated With Increased Rejection Rates and Reduced Glomerular Filtration Rates. Transplantation 2007; 84:972-80. [DOI: 10.1097/01.tp.0000284987.35214.66] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Snoeijs MG, van Heurn LE, van Mook WN, Christiaans MH, van Hooff JP. Controlled donation after cardiac death: a European perspective. Transplant Rev (Orlando) 2007. [DOI: 10.1016/j.trre.2007.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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