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Murakami M, Ishida H, Yanagisawa K, Shinohara H, Ichikawa Y, Osawa K, Furuhata S, Ikezoe M, Iida S, Hirai T, Shirakawa H, Omoto K, Shimizu T, Tanabe K. Living-Donor Kidney Transplantation Performed in a Low-Volume Center by Visiting Surgeons From a High-Volume Center and Managed Clinically Solely by Nephrologists: 1-Year Outcomes. Transplant Proc 2021; 53:872-880. [PMID: 33743981 DOI: 10.1016/j.transproceed.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/25/2020] [Accepted: 02/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Little is known about the outcome of living-donor kidney transplantation (LDKT) performed in low-volume centers lacking the services of full-time transplant surgeons. This retrospective cohort study assessed the outcome of LDKT performed in a low-volume center by visiting transplant surgeons from a high-volume center and managed perioperatively by transplant nephrologists. METHODS We compared Japanese adult patients who had no donor-specific antibodies and underwent LDKT between 2006 and 2015 either in a low-volume (n = 31) or high-volume (n = 481) center. In the low-volume center, visiting transplant surgeons from the high-volume center conducted LDKT and transplant nephrologists managed the recipients peri- and postoperatively. The primary outcome was the composite of infection, cardiovascular disease, or cancer during 1-year follow-up. The outcomes of the low- and high-volume centers were compared using 1:2 propensity score matching. RESULTS After matching, 9 of 29 patients in the low-volume center (31.0%) and 16 of 58 patients in the high-volume center (27.6%) experienced the primary composite outcome (risk ratio = 1.13; 95% confidence interval, 0.57-2.23). There were no significant differences between the 2 groups in graft function at 1 year, all-cause graft loss, biopsy-proven rejection, and urological complications. However, the median duration of post-LDKT hospitalization was significantly longer in the low-volume center than in the high-volume center (23 and 16 days, respectively). CONCLUSIONS Among Japanese patients without preformed donor-specific antibodies, LDKT conducted at a low-volume center by visiting transplant surgeons from a high-volume center and managed clinically by transplant nephrologists was not associated with significantly higher risk of postoperative complications.
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Affiliation(s)
- Minoru Murakami
- Department of Nephrology, Saku Central Hospital, Saku City, Nagano, Japan
| | - Hideki Ishida
- Department of Organ Transplant Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Kazuki Yanagisawa
- Department of Clinical Engineering, Saku Central Hospital, Saku City, Nagano, Japan
| | - Hiromi Shinohara
- Department of Pharmacy, Saku Central Hospital, Saku City, Nagano, Japan
| | - Yuhei Ichikawa
- Department of Pharmacy, Saku Central Hospital, Saku City, Nagano, Japan
| | - Kosuke Osawa
- Department of Nephrology, Saku Central Hospital, Saku City, Nagano, Japan
| | - Shunichi Furuhata
- Department of Nephrology, Saku Central Hospital, Saku City, Nagano, Japan
| | - Masaya Ikezoe
- Department of Nephrology, Saku Central Hospital, Saku City, Nagano, Japan
| | - Shoichi Iida
- Department of Urology, Toda Chuo General Hospital, Toda City, Saitama, Japan
| | - Toshihito Hirai
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hiroki Shirakawa
- Department of Urology, Ohkubo Hospital, Shinjuku-ku, Tokyo, Japan
| | - Kazuya Omoto
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tomokazu Shimizu
- Department of Urology, Toda Chuo General Hospital, Toda City, Saitama, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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Htay H, Pascoe EM, Hawley CM, Campbell SB, Chapman J, Cho Y, Clayton PA, Collins MG, Francis RS, Isbel NM, Lim WH, Putrino S, Johnson DW. Patient and center characteristics associated with kidney transplant outcomes: a binational registry analysis. Transpl Int 2020; 33:1667-1680. [PMID: 32589787 DOI: 10.1111/tri.13681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/14/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Abstract
This registry-based study evaluated the contribution of center characteristics to kidney transplant outcomes in adult first kidney transplant recipients in Australia and New Zealand between 2004 and 2014. Primary outcomes were mortality and graft failure, and secondary outcomes were transplant complications. Overall, 6970 transplants from 17 centers were included. For deceased donor transplants, 5-year patient and graft survival rates varied considerably (81.0-93.9% and 72.2-88.3%, respectively). Variations in mortality and graft failure were partially reduced after adjustment for patient characteristics (1% and 20% reductions) and more markedly reduced after adjustment for center characteristics (41% and 55% reductions). For living donor transplants, 5-year patient and graft survival rates varied (89.7-100% and 79.2-96.9%, respectively). Centers with high average total ischemic times (>14 h) were associated with higher mortality for both deceased (adjusted hazard ratio [(AHR] 2.24, 95% CI 1.21-4.13) and living donor transplants (AHR 1.76, 95% CI 1.02-3.04). Small center size (<35 new kidney transplants/year) was associated with a lower hazard of mortality for living donor kidney transplants (AHR 0.48, 95% CI 0.28-0.81). No center characteristic was associated with graft failure. The appreciable variations in deceased donor kidney transplant recipient and graft survival outcomes across centers were attributable to center effects.
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Affiliation(s)
- Htay Htay
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.,Australasian Kidney Trial Network, University of Queensland, Brisbane, Qld, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trial Network, University of Queensland, Brisbane, Qld, Australia
| | - Carmel M Hawley
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Australasian Kidney Trial Network, University of Queensland, Brisbane, Qld, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia.,Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
| | - Scott B Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Jeremy Chapman
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
| | - Yeoungjee Cho
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Australasian Kidney Trial Network, University of Queensland, Brisbane, Qld, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia.,Translational Research Institute, Brisbane, Qld, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Michael G Collins
- Department of Renal Medicine, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Wai H Lim
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Samantha Putrino
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia.,University of Queensland, Brisbane, Qld, Australia
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Australasian Kidney Trial Network, University of Queensland, Brisbane, Qld, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia.,Translational Research Institute, Brisbane, Qld, Australia
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