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Beerli N, Denhaerynck K, Binet I, Dahdal S, Dickenmann M, Golshayan D, Hadaya K, Huynh-Do U, Schnyder A, De Geest SM, Mauthner O. Age at Time of Kidney Transplantation as a Predictor for Mortality, Graft Loss and Self-Rated Health Status: Results From the Swiss Transplant Cohort Study. Transpl Int 2022; 35:10076. [PMID: 35185365 PMCID: PMC8842256 DOI: 10.3389/ti.2021.10076] [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: 09/29/2021] [Accepted: 12/01/2021] [Indexed: 12/04/2022]
Abstract
Introduction: The effect of age on health outcomes in kidney transplantation remains inconclusive. This study aimed to analyze the relationship between age at time of kidney transplantation with mortality, graft loss and self-rated health status in adult kidney transplant recipients. Methods: This study used data from the Swiss Transplant Cohort Study and included prospective data of kidney transplant recipients between 2008 and 2017. Time-to-event analysis was performed using Cox’ regression analysis, and -in the case of graft loss- competing risk analysis. A random-intercept regression model was applied to analyse self-rated health status. Results: We included 2,366 kidney transplant recipients. Age at transplantation linearly predicted mortality. It was also predictive for graft loss, though nonlinearly, showing that recipients aged between 35 and 55 years presented with the lowest risk of experiencing graft loss. No relationship of age with self-rated health status was detected. Conclusion: Higher mortality in older recipients complies with data from the general population. The non-linear relationship between age and graft loss and the higher scored self-rated health status at all follow-up time-points compared to the pre-transplant status -regardless of age- highlight that age alone might not be an accurate measure for risk prediction and clinical decision making in kidney transplantation.
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Affiliation(s)
- Nadine Beerli
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
| | - Kris Denhaerynck
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Isabelle Binet
- Clinic of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Suzan Dahdal
- University Clinic for Nephrology and Hypertension, University Hospital Bern, Bern, Switzerland
| | - Michael Dickenmann
- Department for Transplantation-Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Delaviz Golshayan
- Transplantation Centre and Transplantation Immunopathology Laboratory, University Hospital Lausanne, Lausanne, Switzerland
| | - Karine Hadaya
- Department of Nephrology, University Hospital Geneva, Geneva, Switzerland
| | - Uyen Huynh-Do
- University Clinic for Nephrology and Hypertension, University Hospital Bern, Bern, Switzerland
| | - Aurelia Schnyder
- Clinic of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Sabina M. De Geest
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Oliver Mauthner
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
- *Correspondence: Oliver Mauthner,
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Harding JL, Pavkov M, Wang Z, Benoit S, Burrows NR, Imperatore G, Albright AL, Patzer R. Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA. BMJ Open Diabetes Res Care 2021; 9:9/1/e001962. [PMID: 33962973 PMCID: PMC8108684 DOI: 10.1136/bmjdrc-2020-001962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Little is known about the role diabetes (type 1 (T1D) and type 2 (T2D)) plays in modifying prognosis among kidney transplant recipients. Here, we compare mortality among transplant recipients with T1D, T2D and non-diabetes-related end-stage kidney disease (ESKD). RESEARCH DESIGN AND METHODS We included 254 188 first-time single kidney transplant recipients aged ≥18 years from the US Renal Data System (2000-2018). Diabetes status, as primary cause of ESKD, was defined using International Classification of Disease 9th and 10th Clinical Modification codes. Multivariable-adjusted Cox regression models (right-censored) computed risk of death associated with T1D and T2D relative to non-diabetes. Trends in standardized mortality ratios (SMRs) (2000-2017), relative to the general US population, were assessed using Joinpoint regression. RESULTS A total of 72 175 (28.4%) deaths occurred over a median survival time of 14.6 years. 5-year survival probabilities were 88%, 85% and 77% for non-diabetes, T1D and T2D, respectively. In adjusted models, mortality was highest for T1D (HR=1.95, (95% CI: 1.88 to 2.03)) and then T2D (1.65 (1.62 to 1.69)), as compared with non-diabetes. SMRs declined for non-diabetes, T1D, and T2D. However, in 2017, SMRs were 2.38 (2.31 to 2.45), 6.55 (6.07 to 7.06), and 3.82 (3.68 to 3.98), for non-diabetes, T1D and T2D, respectively. CONCLUSIONS In the USA, diabetes type is an important modifier in mortality risk among kidney transplant recipients with highest rates among people with T1D-related ESKD. Development of effective interventions that reduce excess mortality in transplant recipients with diabetes is needed, especially for T1D.
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Affiliation(s)
- Jessica L Harding
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Meda Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zhensheng Wang
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stephen Benoit
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nilka Ríos Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ann L Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel Patzer
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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3
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Park WY, Chang YK, Kim YS, Jin K, Yang CW, Han S, Chung BH. Impact of acute kidney injury in deceased donors with high Kidney Donor Profile Index on posttransplant clinical outcomes: a multicenter cohort study. Kidney Res Clin Pract 2021; 40:162-174. [PMID: 33663035 PMCID: PMC8041636 DOI: 10.23876/j.krcp.20.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This study evaluated the impact of acute kidney injury (AKI) on posttransplant clinical outcomes for deceased donor (DD) kidney transplantation (KT) using the Kidney Donor Profile Index (KDPI) system. METHODS Overall, 657 kidney transplant recipients (KTRs) receiving kidneys from 526 DDs from four transplant centers were included. We divided them into the high and low KDPI donor groups by 65%, the KDPI score, and both groups were subdivided into the AKI-DDKT and non-AKI-DDKT subgroups according to AKI in DDs. RESULTS There was no significant difference in the incidence of delayed graft function (DGF) between the high and low KDPI-KTR groups; however, the AKI-DDKT subgroup showed significantly higher incidence of DGF than the non-AKI-DDKT subgroup in both groups (p = 0.001, p < 0.001, respectively). The death-censored graft survival rate was significantly lower in the high KDPI-KTR group than in the low KDPI-KTR group (p = 0.005). Only in the high KDPI-KTR group, the death-censored graft survival rate was significantly lower in the KT from DDs with AKI stage 3 than KT from DDs with non-AKI or AKI stage 1 or 2 (p = 0.040). The interaction between AKI stage 3 in DDs and high KDPI on the allograft outcome was significant (p = 0.002). CONCLUSION KTs from DDs with AKI stage 3 showed an adverse impact on the allograft outcome in the high KDPI-KTR group. Therefore, DDs with a high KDPI score should be managed carefully so that severe AKI does not occur prior to KT.
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Affiliation(s)
- Woo Yeong Park
- Division of Nephrology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Yoon Kyung Chang
- Division of Nephrology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Young Soo Kim
- Division of Nephrology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Kyubok Jin
- Division of Nephrology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Chul Woo Yang
- Transplant Research Center, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungyeup Han
- Division of Nephrology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Byung Ha Chung
- Transplant Research Center, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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4
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Park WY, Kim JH, Ko EJ, Min JW, Ban TH, Yoon HE, Kim YS, Jin K, Yang CW, Han S, Chung BH. Impact of Kidney Donor Profile Index Scores on Post-Transplant Clinical Outcomes Between Elderly and Young Recipients, A Multicenter Cohort Study. Sci Rep 2020; 10:7009. [PMID: 32332846 PMCID: PMC7181596 DOI: 10.1038/s41598-020-64055-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/02/2020] [Indexed: 12/17/2022] Open
Abstract
We investigated if clinical outcomes after kidney transplantation (KT) from deceased donors (DDs) with high Kidney Donor Profile Index (KDPI) can be different according to the age of KT recipients (KTRs). Six-hundred fifty-seven KTRs from 526 DDs were included from four transplant centers. We divided KTRs into elderly-KTR and young-KTR groups based on age 60 and each group was subdivided into high- or low-KDPI subgroup based on KDPI score of 65%. We compared short-term and long-term clinical outcomes among those four subgroups (low KDPI-young KTR, low KDPI-elderly-KTR, high KDPI-young-KTR, high KDPI-elderly-KTR). In short-term outcomes including acute rejection, BK virus and CMV infection, there was no significant difference among the four subgroups. In the long-term outcomes, the development of cardiovascular disease was higher in the high KDPI-elderly-KTR group than the other groups. In comparison of allograft survival rate, the high KDPI-young KTR subgroup showed highest risk for allograft failure and there was significant interaction between high-KDPI donors and young-KTR on allograft survival rate (P = 0.002). However, there was no significant difference in comparison of the patient survival rate. In conclusion, clinical impact of high-KDPI in DDs on post-transplant allograft survival may be less significant in elderly-KTR than in young-KTR.
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Affiliation(s)
- Woo Yeong Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.,Keimyung University Kidney Institute, Daegu, Republic of Korea
| | - Jeong Ho Kim
- Division of Nephrology, Department of Internal Medicine, Daejeon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Eun Jung Ko
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Won Min
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Tae Hyun Ban
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye-Eun Yoon
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Young Soo Kim
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Uijeongbu St. Mary's hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Kyubok Jin
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.,Keimyung University Kidney Institute, Daegu, Republic of Korea
| | - Chul Woo Yang
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungyeup Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea. .,Keimyung University Kidney Institute, Daegu, Republic of Korea.
| | - Byung Ha Chung
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. .,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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5
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Park WY, Kim JH, Ko EJ, Min JW, Ban TH, Yoon HE, Kim YS, Jin K, Han S, Yang CW, Chung BH. Impact of acute kidney injury in elderly versus young deceased donors on post-transplant outcomes: A multicenter cohort study. Sci Rep 2020; 10:3727. [PMID: 32111949 PMCID: PMC7048728 DOI: 10.1038/s41598-020-60726-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/10/2020] [Indexed: 12/29/2022] Open
Abstract
We investigated the impact of acute kidney injury (AKI) in elderly deceased-donors (DDs) vs. AKI in young DDs on post-transplant clinical outcomes. A total of 709 kidney transplant recipients (KTRs) from 602 DDs at four transplant centers were enrolled. KTRs were divided into young-DDKT and elderly-DDKT groups according to the age of DD of 60 years. Both groups were subdivided into non-AKI-KT and AKI-KT subgroups according to AKI in DDs. We investigated short-term and long-term clinical outcomes of non-AKI-DDKT and AKI-DDKT subgroups within young-DDKT and elderly-DDKT groups. The incidence of DGF in the AKI-DDKT subgroup was higher and the allograft function within 12 months after KT in the AKI-DDKT subgroup was lower than those in the non-AKI-DDKT subgroup in both young-DDKT and elderly-DDKT groups. Death-censored allograft survival rate was significantly lower in the AKI-elderly-DDKT subgroup than that in the non-AKI-elderly-DDKT subgroup, but it did not differ between AKI-young-DDKT and non-AKI-young-DDKT subgroup. In multivariable analysis, AKI-elderly-DDKT was an independent risk factor for allograft failure (hazard ratio: 2.648, 95% CI: 1.170-5.994, p = 0.019) and a significant interaction between AKI and old age in DDs on allograft failure was observed (p = 0.001). AKI in elderly DDs, but not in young DDs, can significantly affect long-term allograft outcomes of KTRs.
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Affiliation(s)
- Woo Yeong Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
- Keimyung University Kidney Institute, Daegu, Republic of Korea
| | - Jeong Ho Kim
- Division of Nephrology, Department of Internal Medicine, Daejeon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Eun Jung Ko
- Transplant research center, Seoul, Republic of Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Won Min
- Transplant research center, Seoul, Republic of Korea
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Tae Hyun Ban
- Transplant research center, Seoul, Republic of Korea
- Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye-Eun Yoon
- Transplant research center, Seoul, Republic of Korea
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Young Soo Kim
- Transplant research center, Seoul, Republic of Korea
- Division of Nephrology, Department of Internal Medicine, Uijeongbu St. Mary's hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Kyubok Jin
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
- Keimyung University Kidney Institute, Daegu, Republic of Korea
| | - Seungyeup Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
- Keimyung University Kidney Institute, Daegu, Republic of Korea
| | - Chul Woo Yang
- Transplant research center, Seoul, Republic of Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung Ha Chung
- Transplant research center, Seoul, Republic of Korea.
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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6
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Schwager Y, Littbarski SA, Nolte A, Kaltenborn A, Emmanouilidis N, Kleine-Döpke D, Klempnauer J, Schrem H. Prediction of Three-Year Mortality After Deceased Donor Kidney Transplantation in Adults with Pre-Transplant Donor and Recipient Variables. Ann Transplant 2019; 24:273-290. [PMID: 31097680 PMCID: PMC6540619 DOI: 10.12659/aot.913217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Prognostic models for 3-year mortality after kidney transplantation based on pre-transplant donor and recipient variables may avoid futility and thus improve donor organ allocation. Material/Methods There were 1546 consecutive deceased-donor kidney transplants in adults (January 1, 2000 to December 31, 2012) used to identify pre-transplant donor and recipient variables with significant independent influence on long-term survival (Cox regression modelling). Detected factors were used to develop a prognostic model for 3-year mortality in 1289 patients with follow-up of >3 years (multivariable logistic regression). The sensitivity and specificity of this model’s prognostic ability was assessed with the area under the receiver operating characteristic curve (AUROC). Results Highly immunized recipients [hazard ratio (HR: 2.579, 95% CI: 1.272–4.631], high urgency recipients (HR: 3.062, 95% CI: 1.294–6.082), recipients with diabetic nephropathy (HR: 3.471, 95% CI: 2.476–4.751), as well as 0, 1, or 2 HLA DR mismatches (HR: 1.349, 95% CI: 1.160–1.569) were independent and significant risk factors for patient survival. Younger recipient age ≤42.1 years (HR: 0.137, 95% CI: 0.090–0.203), recipient age 42.2–52.8 years (HR: 0.374, 95% CI: 0.278–0.498), recipient age 52.9–62.8 years (HR: 0.553, 95% CI: 0.421–0.723), short cold ischemic times ≤11.8 hours (HR: 0.602, 95% CI: 0.438–0.814) and cold ischemic times 11.9–15.3 hours (HR: 0.736, 95% CI: 0.557–0.962) reduced this risk independently and significantly. The AUROC of the derived model for 3-year post-transplant mortality with these variables was 0.748 (95% CI: 0.689–0.788). Conclusions Older, highly immunized or high urgency transplant candidates with anticipated longer cold ischemic times, who were transplanted with the indication of diabetic nephropathy should receive donor organs with no HLA DR mismatches to improve their mortality risk.
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Affiliation(s)
- Ysabell Schwager
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Simon Alexander Littbarski
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Almut Nolte
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Alexander Kaltenborn
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Nikos Emmanouilidis
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Dennis Kleine-Döpke
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Jürgen Klempnauer
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Harald Schrem
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.,Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.,Department of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
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7
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Ko EJ, Yang J, Ahn C, Kim MS, Han DJ, Kim SJ, Yang CW, Chung BH, Ahn C, Chae DW, Yang J, Choi BS, Jung CW, Kim MS, Kwon OJ, Kim S, Kim YH, Choi S, Han SY, Han DJ, Lee SH, Jeong KH, Kim SJ, Jeon JS, Park YH, Roh YN, Lee JJ, Lee KW, Han SY, Kim CD, Park JW, Kim JK, Lee DR, Lee DW, Seong EY, Kong JM, Cho HR, Park SK, Lee SY, Park JH. Clinical outcomes of kidney transplantation in older end‐stage renal disease patients: A nationwide cohort study. Geriatr Gerontol Int 2019; 19:392-398. [DOI: 10.1111/ggi.13630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/13/2018] [Accepted: 01/09/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Eun Jeong Ko
- Transplantation Research Center, Division of Nephrology, Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Korea
| | - Jaeseok Yang
- Department of Transplantation CenterSeoul National University Hospital Jongno Korea
| | - Curie Ahn
- Department of Transplantation CenterSeoul National University Hospital Jongno Korea
- Department of Internal Medicine‐NephrologySeoul National University Hospital Jongno Korea
| | - Myoung Soo Kim
- Department of Surgery‐TransplantationSeverance Hospital Seodaemun Korea
| | - Duck Jong Han
- Department of Surgery‐TransplantationAsan Medical Center, University of Ulsan College of Medicine Songpa Korea
| | - Sung Joo Kim
- Department of Surgery‐TransplantationSamsung Medical Center Gangnam Korea
| | - Chul Woo Yang
- Transplantation Research Center, Division of Nephrology, Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Korea
| | - Byung Ha Chung
- Transplantation Research Center, Division of Nephrology, Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Korea
| | - Curie Ahn
- Transplantation CenterSeoul National University Hospital
| | - Dong Wan Chae
- Transplantation CenterSeoul National University Hospital
| | - Jaeseok Yang
- Transplantation CenterSeoul National University Hospital
| | - Bum Soon Choi
- Department of Internal Medicinethe Catholic University of Korea
| | | | - Myoung Soo Kim
- Department of Surgery, Severance HospitalYonsei University College of Medicine
| | - Oh Jung Kwon
- Department of SurgeryHanyang University Hospital
| | - Sung‐Joo Kim
- Department of Surgery, Samsung Medical CenterSungkyunkwan University School of Medicine
| | - Yeong Hoon Kim
- Organ Transplantation Center, Busan Paik HospitalInje University College of Medicine
| | | | - Seung Yeup Han
- Department of Internal MedicineKeimyung University School of Medicine
| | - Duck Jong Han
- Department of SurgeryUlsan Medical Center and University of Ulsan College of Medicine
| | - Sang Ho Lee
- Department of Internal MedicineKyunghee University College of Medicine
| | - Kyung Hwan Jeong
- Department of Internal MedicineKyunghee University College of Medicine
| | - Seung Jung Kim
- Department of Internal MedicineEwha Womans University Medical Center
| | - Jin Seok Jeon
- Department of Internal MedicineSoon Chun Hyang University Hospital
| | - Yeon Ho Park
- Department of SurgeryGachon University Gil Medical Center
| | - Young Nam Roh
- Organ Transplantation CenterInje University Ilsan Paik Hospital
| | - Jeong Joon Lee
- Department of Surgery, CHA Bundang Medical CenterCHA university
| | - Kang Wook Lee
- Department of Internal MedicineChungnam National University Hospital
| | - Seung Yeup Han
- Department of Internal MedicineKeimyung University Dongsan Medical Center
| | - Chan Duck Kim
- Department of Internal MedicineKyungpook National University Hospital
| | - Jong Won Park
- Department of Internal MedicineYeungnam University Hospital
| | | | | | - Dong Won Lee
- Department of Internal MedicinePusan National University Hospital
| | - Eun Young Seong
- Department of Internal MedicinePusan National University Hospital
| | - Jin Min Kong
- Department of Internal MedicineBHS Han Seo Hospital
| | | | - Sung Kwang Park
- Department of Internal MedicineChonbuk National University Hospital
| | | | - Jung Hwan Park
- Department of Internal MedicineKonkuk University Medical Center
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8
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Park WY, Choi MS, Kim YS, Choi BS, Park CW, Yang CW, Kim YS, Jin K, Han S, Chung BH. Impact of acute kidney injury in expanded criteria deceased donors on post-transplant clinical outcomes: multicenter cohort study. BMC Nephrol 2019; 20:39. [PMID: 30717699 PMCID: PMC6360778 DOI: 10.1186/s12882-019-1225-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 01/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background The problem of organ shortage is an important issue in kidney transplantation, but the effect of kidney donation on AKI is unclear. The aim of this study was to investigate the impact of acute kidney injury (AKI) on post-transplant clinical outcomes for deceased donor kidney transplantation (DDKT) using standard criteria donors (SCDs) versus expanded criteria donors (ECDs). Methods Five-hundred nine KT recipients receiving kidneys from 386 deceased donors (DDs) were included from three transplant centers. Recipients were classified into the SCD-KT or ECD-KT group according to corresponding DDs and both groups were divided into the AKI-KT or non-AKI-KT subgroups according to AKI in donor. We compared the clinical outcomes among those four groups and investigated the interaction between AKI in donors and ECD on allograft outcome. Results The incidence of delayed allograft function was higher when the donors had AKI within SCD-KT and ECD-KT groups. In allograft biopsies within 3 months, chronic change was more significant in the AKI-ECD-KT subgroup than in the non-AKI-ECD-KT subgroup, but it did not differ between AKI-SCD-KT and non-AKI-SCD-KT group. AKI-ECD-KT showed higher risk for death-censored allograft failure than the other three groups and a significant interaction was observed between AKI in donors and ECD on the allograft outcome. Conclusions The presence of AKI in ECDs significantly impacted the long-term allograft outcomes of kidney transplant recipients, but it did not in SCDs. Electronic supplementary material The online version of this article (10.1186/s12882-019-1225-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Woo Yeong Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea.,Keimyung University Kidney Institute, Daegu, South Korea
| | - Min-Seok Choi
- Transplant Research Center, Seoul, South Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young Soo Kim
- Division of Nephrology, Department of Internal Medicine, Uijeongbu St. Mary's hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea
| | - Bum Soon Choi
- Transplant Research Center, Seoul, South Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Cheol Whee Park
- Transplant Research Center, Seoul, South Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chul Woo Yang
- Transplant Research Center, Seoul, South Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yong-Soo Kim
- Transplant Research Center, Seoul, South Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyubok Jin
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea.,Keimyung University Kidney Institute, Daegu, South Korea
| | - Seungyeup Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea.,Keimyung University Kidney Institute, Daegu, South Korea
| | - Byung Ha Chung
- Transplant Research Center, Seoul, South Korea. .,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Ortiz F, Harjutsalo V, Helanterä I, Lempinen M, Forsblom C, Groop PH. Long-term Mortality After Kidney Transplantation in a Nationwide Cohort of Patients With Type 1 Diabetes in Finland. Diabetes Care 2019; 42:55-61. [PMID: 30389672 DOI: 10.2337/dc18-1029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/09/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine time trends in mortality rates and causes of death in patients with type 1 diabetes and end-stage renal disease on dialysis and after kidney transplantation. RESEARCH DESIGN AND METHODS In a nationwide retrospective cohort analysis, all patients with type 1 diabetes in Finland who received a kidney transplant alone were compared with patients who remained on dialysis. The main outcome was patient survival after starting dialysis. The cohort was divided into dialysis, functioning kidney transplant, and dialysis after transplant loss. Causes of death were retrieved and standardized mortality ratios calculated. RESULTS We studied 2,383 patients. Patients survived a median of 15.9 years after a successful transplant, 11.2 years if transplant function was lost, and 2.9 years if they remained on chronic dialysis. Standardized mortality ratio decreased in all subgroups during the past four decades: from 2005 onwards, it was 3.9 in patients receiving a kidney transplant, 11.5 in patients with graft loss, and 32.5 in patients on dialysis. The most common cause of death in all patients was ischemic heart disease (45%) followed by infection (18%), which was more common in patients on dialysis. CONCLUSIONS Kidney transplantation is the treatment of choice for patients with type 1 diabetes and end-stage renal disease because it substantially reduces the excess death risk when compared with dialysis. Even when kidney graft function is lost, the excess death risk is still considerably lower. Although overall mortality has decreased over the years, premature death due to ischemic heart disease remains high.
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Affiliation(s)
- Fernanda Ortiz
- Nephrology, Abdominal Center, Helsinki University Hospital, Helsinki, Finland .,Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
| | - Valma Harjutsalo
- Nephrology, Abdominal Center, Helsinki University Hospital, Helsinki, Finland.,Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Diabetes and Obesity, University of Helsinki Research Programs Unit, Helsinki, Finland.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Ilkka Helanterä
- Transplantation and Liver Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Marko Lempinen
- Transplantation and Liver Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Carol Forsblom
- Nephrology, Abdominal Center, Helsinki University Hospital, Helsinki, Finland.,Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Diabetes and Obesity, University of Helsinki Research Programs Unit, Helsinki, Finland
| | - Per-Henrik Groop
- Nephrology, Abdominal Center, Helsinki University Hospital, Helsinki, Finland.,Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Diabetes and Obesity, University of Helsinki Research Programs Unit, Helsinki, Finland.,Department of Diabetes, Monash University Central Clinical School, Melbourne, Victoria, Australia
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10
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Low-risk Prostate Cancer Prior to or After Kidney Transplantation. Eur Urol Focus 2018; 4:148-152. [PMID: 30005996 DOI: 10.1016/j.euf.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/18/2018] [Accepted: 07/02/2018] [Indexed: 12/12/2022]
Abstract
CONTEXT Organ transplantation requires immunosuppression, which was regarded as a risk factor for tumor induction and tumor progression in all types of malignancy. Until recently, any form of active neoplasia was, therefore, regarded as contraindicative to organ transplantation. However, there is growing evidence that the increased tumor risk by immunosuppression is restricted to particular subgroups of malignancy, whereas others such as prostate cancer (PCa) are not negatively influenced. OBJECTIVE To compare life expectancy (LE) under various low-risk situations of PCa (untreated low-risk primary tumor, slowly progressing asymptomatic biochemical recurrence after curative treatment) with LE under renal replacement therapy. To discuss the question whether or not low-risk untreated or incurable situations of PCa must be regarded contraindicative to kidney transplantation (KT) or to transplantation of other organs. EVIDENCE ACQUISITION A systematic literature search was conducted using PubMed to identify original and review articles regarding PCa risk after KT as well as the natural history of untreated and treated situations of PCa. Articles published between 1991 and 2018 were reviewed and selected with the consensus of all the authors. EVIDENCE SYNTHESIS No evidence could be found that KT and immunosuppression are associated with an increased PCa-related risk, neither in incidence nor in aggressiveness. CONCLUSIONS Screening for and treatment of PCa in applicants for KT or in patients after KT should be performed in an individualized manner on the basis of lifetime risk calculations. In particular, untreated or incurable low-risk manifestations (presumed LE >10 yr) of PCa cannot be regarded as strictly contraindicative against KT. PATIENT SUMMARY For prostate cancer, even when left untreated, a number of low-risk situations can be defined which are associated with a life expectancy (LE) of 15 yr and more. The LE of elderly patients suffering from end-stage renal failure often does not significantly exceed 15 yr even after kidney transplantation (KT). When remaining on dialysis, however, their further LE is significantly reduced and often far below 15 yr. To the best of the presently available knowledge, KT does not worsen or accelerate the course of untreated low-risk prostate cancer. Even in the presence of untreated low-risk prostate cancer, patients with end-stage renal failure must, therefore, be expected to significantly benefit from KT.
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11
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Abstract
BACKGROUND Currently, potential kidney transplant patients more often suffer from comorbidities. The Charlson Comorbidity Index (CCI) was developed in 1987 and is the most used comorbidity score. We questioned to what extent number and severity of comorbidities interfere with graft and patient survival. Besides, we wondered whether the CCI was best to study the influence of comorbidity in kidney transplant patients. METHODS In our center, 1728 transplants were performed between 2000 and 2013. There were 0.8% cases with missing values. Nine pretransplant comorbidity covariates were defined: cardiovascular disease, cerebrovascular accident, peripheral vascular disease, diabetes mellitus, liver disease, lung disease, malignancy, other organ transplantation, and human immunodeficiency virus positivity. The CCI used was unadjusted for recipient age. The Rotterdam Comorbidity in Kidney Transplantation score was developed, and its influence was compared to the CCI. Kaplan-Meier analysis and multivariable Cox proportional hazards analysis, corrected for variables with a known significant influence, were performed. RESULTS We noted 325 graft failures and 215 deaths. The only comorbidity covariate that significantly influenced graft failure censored for death was peripheral vascular disease. Patient death was significantly influenced by cardiovascular disease, other organ transplantation, and the total comorbidity scores. Model fit was best with the Rotterdam Comorbidity in Kidney Transplantation score compared to separate comorbidity covariates and the CCI. In the population with the highest comorbidity score, 50% survived more than 10 years. CONCLUSIONS Despite the negative influence of comorbidity, patient survival after transplantation is remarkably good. This means that even patients with extensive comorbidity should be considered for transplantation.
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12
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Lorent M, Giral M, Pascual M, Koller MT, Steiger J, Trébern-Launay K, Legendre C, Kreis H, Mourad G, Garrigue V, Rostaing L, Kamar N, Kessler M, Ladrière M, Morelon E, Buron F, Golshayan D, Foucher Y. Mortality Prediction after the First Year of Kidney Transplantation: An Observational Study on Two European Cohorts. PLoS One 2016; 11:e0155278. [PMID: 27152510 PMCID: PMC4859488 DOI: 10.1371/journal.pone.0155278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/26/2016] [Indexed: 11/18/2022] Open
Abstract
After the first year post transplantation, prognostic mortality scores in kidney transplant recipients can be useful for personalizing medical management. We developed a new prognostic score based on 5 parameters and computable at 1-year post transplantation. The outcome was the time between the first anniversary of the transplantation and the patient’s death with a functioning graft. Afterwards, we appraised the prognostic capacities of this score by estimating time-dependent Receiver Operating Characteristic (ROC) curves from two prospective and multicentric European cohorts: the DIVAT (Données Informatisées et VAlidées en Transplantation) cohort composed of patients transplanted between 2000 and 2012 in 6 French centers; and the STCS (Swiss Transplant Cohort Study) cohort composed of patients transplanted between 2008 and 2012 in 6 Swiss centers. We also compared the results with those of two existing scoring systems: one from Spain (Hernandez et al.) and one from the United States (the Recipient Risk Score, RRS, Baskin-Bey et al.). From the DIVAT validation cohort and for a prognostic time at 10 years, the new prognostic score (AUC = 0.78, 95%CI = [0.69, 0.85]) seemed to present significantly higher prognostic capacities than the scoring system proposed by Hernandez et al. (p = 0.04) and tended to perform better than the initial RRS (p = 0.10). By using the Swiss cohort, the RRS and the the new prognostic score had comparable prognostic capacities at 4 years (AUC = 0.77 and 0.76 respectively, p = 0.31). In addition to the current available scores related to the risk to return in dialysis, we recommend to further study the use of the score we propose or the RRS for a more efficient personalized follow-up of kidney transplant recipients.
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Affiliation(s)
- Marine Lorent
- EA 4275 SPHERE—Biostatistics, Clinical Research and Pharmaco-Epidemiology. Nantes University, Nantes, France
- Transplantation, Urology and Nephrology Institute (ITUN)—INSERM U1064, CHU Nantes, Nantes, France
| | - Magali Giral
- Transplantation, Urology and Nephrology Institute (ITUN)—INSERM U1064, CHU Nantes, Nantes, France
- CIC Biotherapy, CHU Nantes, Nantes, France
- * E-mail:
| | - Manuel Pascual
- Transplantation Center, CHUV and University of Lausanne, Lausanne, Switzerland
| | - Michael T. Koller
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Jürg Steiger
- Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Katy Trébern-Launay
- EA 4275 SPHERE—Biostatistics, Clinical Research and Pharmaco-Epidemiology. Nantes University, Nantes, France
- Transplantation, Urology and Nephrology Institute (ITUN)—INSERM U1064, CHU Nantes, Nantes, France
| | - Christophe Legendre
- Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP Paris, Paris, France
- Universités Paris Descartes et Sorbonne Paris Cité, Paris, France
| | - Henri Kreis
- Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP Paris, Paris, France
- Universités Paris Descartes et Sorbonne Paris Cité, Paris, France
| | - Georges Mourad
- Service de Néphrologie-Transplantation, Hôpital Lapeyronie, Montpellier, France
| | - Valérie Garrigue
- Service de Néphrologie-Transplantation, Hôpital Lapeyronie, Montpellier, France
| | - Lionel Rostaing
- Service de Néphrologie, HTA, Dialyse et Transplantation d'Organes, CHU Rangueil, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | - Nassim Kamar
- Service de Néphrologie, HTA, Dialyse et Transplantation d'Organes, CHU Rangueil, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | - Michèle Kessler
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | - Marc Ladrière
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | - Emmanuel Morelon
- Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
| | - Fanny Buron
- Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
| | - Dela Golshayan
- Transplantation Center, CHUV and University of Lausanne, Lausanne, Switzerland
| | - Yohann Foucher
- EA 4275 SPHERE—Biostatistics, Clinical Research and Pharmaco-Epidemiology. Nantes University, Nantes, France
- Transplantation, Urology and Nephrology Institute (ITUN)—INSERM U1064, CHU Nantes, Nantes, France
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Tittelbach-Helmrich D, Thurow C, Arwinski S, Schleicher C, Hopt UT, Bausch D, Drognitz O, Pisarski P. Poor organ quality and donor-recipient age mismatch rather than poor donation rates account for the decrease in deceased kidney transplantation rates in a Germany Transplant Center. Transpl Int 2014; 28:191-8. [PMID: 25345374 DOI: 10.1111/tri.12478] [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: 07/03/2014] [Revised: 07/12/2014] [Accepted: 10/17/2014] [Indexed: 12/21/2022]
Abstract
Kidney transplantation is limited not by technical or immunological challenges but by lack of donor organs. Whereas the number of patients on waiting list increased, the transplantation rate decreased. We analyzed the development of decline rates and reasons as well as the fate of declined organs. In total, 1403 organs offered to 1950 patients between 2001 and 2010 were included. Of 440 organs offered between 2009 and 2011 that were declined, we investigated whether these organs were transplanted elsewhere and requested delayed graft function, creatinine, graft and patient survival. Data were compared to results of transplantations at the same time at our center. Decline rate increased from 47% to 87%. Main reasons were poor organ quality and donor-recipient age or size mismatch. Of the rejected organs, 55% were transplanted at other centers with function, graft and patient survival equivalent to patients transplanted at our center during that period. The number of decline has increased over time mainly due to a growing number of marginal donors accounting for poor organ quality or a mismatch of donor and recipient. If proper donor-recipient selection is performed, many organs that would otherwise be discarded can be transplanted successfully.
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Affiliation(s)
- Dietlind Tittelbach-Helmrich
- Department of Surgery, University of Freiburg, Freiburg, Germany; Department of Surgery, University of Lübeck, Lübeck, Germany
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