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Swanson KJ, Zhong W, Mandelbrot DA, Parajuli S. Histopathological Features and Role of Allograft Kidney Biopsy Among Recipients With Prolonged Delayed Graft Function: A Review. Transplantation 2024:00007890-990000000-00665. [PMID: 38383958 DOI: 10.1097/tp.0000000000004928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Delayed graft function (DGF) is an early posttransplant complication predictive of adverse outcomes. This "acute kidney injury of transplantation" is often defined as allograft dysfunction requiring renal replacement within 7 d posttransplantation. DGF is an important area of study because it is emerging with efforts to expand the donor pool and address the supply-demand gap in kidney transplantation. DGF is often caused by severe kidney injury mechanisms because of multiple donors, recipients, and immunologic factors. The role of kidney biopsy, particularly in prolonged DGF, is an ongoing area of research and inquiry for clinicians and researchers alike to better define, manage, and predict outcomes of this early posttransplant event. This review aims to provide an in-depth, comprehensive summary of the literature to date on the histopathology of DGF and the role of kidney transplant biopsies in prolonged DGF.
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Affiliation(s)
- Kurtis J Swanson
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Weixiong Zhong
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Didier A Mandelbrot
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sandesh Parajuli
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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2
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Greenberg JW, Hogue S, Raees MA, Ahmed HF, Abplanalp WA, Guzman-Gomez A, Abdelhamed Z, Thangappan K, Reagor JA, Rose JE, Collins M, Kasten JL, Goldstein SL, Zafar F, Morales DLS, Cooper DS. Exogenous nitric oxide delivery protects against cardiopulmonary bypass-associated acute kidney injury: Histologic and serologic evidence from an ovine model. J Thorac Cardiovasc Surg 2023; 166:e164-e173. [PMID: 37164051 DOI: 10.1016/j.jtcvs.2023.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Several human studies have associated nitric oxide administration via the cardiopulmonary bypass circuit with decreased incidence of cardiopulmonary bypass-associated acute kidney injury, but histopathologic and serologic evidence of nitric oxide efficacy for acute kidney injury attenuation are lacking. METHODS By using a survival ovine model (72 hours), acute kidney injury was induced by implementing low-flow cardiopulmonary bypass for 2 hours, followed by full-flow cardiopulmonary bypass for 2 hours. The nitric oxide cohort (n = 6) received exogenous nitric oxide through the cardiopulmonary bypass circuit via the oxygenator, and the control group (n = 5) received no nitric oxide. Serial serologic biomarkers and renal histopathology were obtained. RESULTS Baseline characteristics (age, weight) and intraoperative parameters (cardiopulmonary bypass time, urine output, heart rate, arterial pH, and lactate) were equivalent (P > .10) between groups. Postoperatively, urine output, heart rate, respiratory rate, and peripheral arterial saturation were equivalent (P > .10) between groups. Post-cardiopulmonary bypass creatinine elevations from baseline were significantly greater in the control group versus the nitric oxide group at 16, 24, and 48 hours (all P < .05). Histopathologic evidence of moderate/severe acute kidney injury (epithelial necrosis, tubular slough, cast formation, glomerular edema) occurred in 60% (3/5) of the control group versus 0% (0/6) of the nitric oxide group. Cortical tubular epithelial cilia lengthening (a sensitive sign of cellular injury) was significantly greater in the control group than in the nitric oxide group (P = .012). CONCLUSIONS In a survival ovine cardiopulmonary bypass model, nitric oxide administered with cardiopulmonary bypass demonstrated serologic and histologic evidence of renal protection from acute kidney injury. These results provide insight into 1 potential mechanism for cardiopulmonary bypass-associated acute kidney injury and supports continued study of nitric oxide via cardiopulmonary bypass circuit for prevention of acute kidney injury.
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Affiliation(s)
- Jason W Greenberg
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Spencer Hogue
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Muhammad Aanish Raees
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Hosam F Ahmed
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - William A Abplanalp
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amalia Guzman-Gomez
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Zakia Abdelhamed
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karthik Thangappan
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James A Reagor
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James E Rose
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michaela Collins
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jennifer L Kasten
- Division of Pathology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stuart L Goldstein
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Farhan Zafar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David S Cooper
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Shahmirzadi MR, Gunaratnam L, Jevnikar AM, Luke P, House AA, Silverman MS, Hosseini-Moghaddam SM. The effect of late-onset CMV infection on the outcome of renal allograft considering initial graft function. Transpl Infect Dis 2023; 25:e14081. [PMID: 37247212 DOI: 10.1111/tid.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Delayed graft function (DGF) increases the renal allograft failure risk. Late-onset Cytomegalovirus (CMV) infection's effect on the association between DGF and allograft failure has not been determined. METHODS In this retrospective cohort, we included all renal allograft recipients at London Health Sciences Centre from January 1, 2014 to December 30, 2017, and continued clinical follow-up until February 28, 2020. We determined whether late-onset CMV infection affects the association between DGF and allograft failure in stratified and Cox proportional hazard analyses. RESULTS Of 384 patients (median age [interquartile range]: 55 [43.3-63]; 38.7% female), 57 recipients (14.8%) were diagnosed with DGF. Patients with DGF were at a greater risk of CMV infection than patients without DGF (22.8% vs. 11.3%, p = .017). Late-onset CMV infection (odds ratio [OR]: 4.7, 95% CI: 2.07-10.68) and rejection (OR: 9.59, 95% CI: 4.15-22.16) significantly increased the risk of allograft failure in recipients with DGF. Patients with DGF had a significantly greater risk of graft failure than those without DGF (17.5% vs. 6.1%, p = .007). In the adjusted Cox hazard model, CMV infection significantly increased the risk of allograft failure (aHR: 3.19, 95% CI: 1.49-6.84). CONCLUSION Late-onset CMV infection considerably increased the risk of graft failure in patients with DGF. A hybrid preventive model including prophylaxis followed by CMV-specific cell-mediated immunity monitoring may decrease the risk of allograft failure in recipients with DGF.
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Affiliation(s)
- Mohammadreza R Shahmirzadi
- Multiorgan Transplant Program, London Health Sciences Centre, Western University, London, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Toronto, Ontario, Canada
| | - Lakshman Gunaratnam
- Multiorgan Transplant Program, London Health Sciences Centre, Western University, London, Ontario, Canada
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anthony M Jevnikar
- Multiorgan Transplant Program, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Patrick Luke
- Multiorgan Transplant Program, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Andrew A House
- Multiorgan Transplant Program, London Health Sciences Centre, Western University, London, Ontario, Canada
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Michael S Silverman
- Division of Infectious Diseases, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Toronto, Ontario, Canada
| | - Seyed M Hosseini-Moghaddam
- Division of Infectious Diseases, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Toronto, Ontario, Canada
- Multiorgan Transplant Program, Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Lin X, Liu X, Wu X, Xie X, Liu G, Wu J, Peng W, Wang R, Chen J, Huang H. Wide-spectrum antibiotic prophylaxis guarantees optimal outcomes in drowned donor kidney transplantation. Expert Rev Anti Infect Ther 2023; 21:203-211. [PMID: 36573685 DOI: 10.1080/14787210.2023.2163237] [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: 12/28/2022]
Abstract
BACKGROUND Drowned victims possibly obtain various pathogens from drowning sites. Using drowned renal donors to expand the donor pool still lacks consensus due to the potential risk of disease transmission. RESEARCH DESIGN AND METHODS This retrospective study enrolled 38 drowned donor renal recipients in a large clinical center from August 2012 to February 2021. A 1:2 matched cohort was generated with donor demographics, including age, gender, BMI, and ICU durations. Donor microbiological results, recipient perioperative infections, and early post-transplant and first-year clinical outcomes were analyzed. RESULTS Compared to the control group, drowned donors had significantly increased positive fungal cultures (36.84% vs.13.15%, p = 0.039). Recipients in the drowned group had significantly higher rates of gram-negative bacteria (GNB) and multidrug-resistant GNB infections (23.68% vs.5.26%, 18.42% vs. 3.95%, both p < 0.05). Other colonization and infections were also numerically more frequent in the drowned group. Drowned donor recipients receiving inadequate antibiotic prophylaxis had more perioperative bloodstream infections, higher DGF incidences, and more first-year respiratory tract infections and recipient loss than those receiving adequate prophylaxis (all p < 0.05). Clinical outcomes were similar between the adequate group and the control group. CONCLUSIONS Drowned donors could be suitable options under wide-spectrum and adequate antimicrobial prophylaxis.
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Affiliation(s)
- Xiaoli Lin
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China.,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China.,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Xinyu Liu
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China.,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China.,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Xiaoying Wu
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China.,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China.,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Xishao Xie
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China.,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China.,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Guangjun Liu
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China.,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China.,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Jianyong Wu
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China.,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China.,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Wenhan Peng
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China.,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China.,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Rending Wang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China.,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China.,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China.,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China.,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Hongfeng Huang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China.,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China.,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
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Wang J, Liu J, Wu W, Yang S, Liu L, Fu Q, Li J, Chen X, Deng R, Wu C, Long S, Zhang W, Zhang H, Mao H, Chen W. Combining Clinical Parameters and Acute Tubular Injury Grading Is Superior in Predicting the Prognosis of Deceased-Donor Kidney Transplantation: A 7-Year Observational Study. Front Immunol 2022; 13:912749. [PMID: 35844570 PMCID: PMC9279653 DOI: 10.3389/fimmu.2022.912749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundWe developed a pragmatic dichotomous grading criterion to stratify the acute tubular injury (ATI) of deceased-donor kidneys. We intended to verify the predictive value of this criterion for the prognosis of deceased-donor kidney transplantation.MethodsThe allografts with ATI were classified into severe and mild groups. Severe ATI was defined as the presence of extreme and diffuse flattening of the tubular epithelial cells, or denudement of the tubular basement membrane. The clinical delayed graft function (DGF) risk index was calculated based on a regression model for posttransplant DGF using 17 clinical parameters related to donor–recipient characteristics.ResultsA total of 140 recipients were enrolled: 18 severe and 122 mild ATI. Compared with the mild ATI group, the severe ATI group had more donors after cardiac death, higher median donor terminal serum creatinine level (dScr), and longer median cold ischemia time. Severe ATI had a higher DGF rate (55.6% vs 14.6%, p < 0.001), longer DGF recovery time (49.6 vs 26.3 days, p < 0.001), and a lower estimated glomerular filtration rate (eGFR) at 1 month (23.5 vs 54.0 ml/min/1.73 m2, p < 0.001), 3 months (40.4 vs 59.0, p = 0.001), and 6 months after transplant (46.8 vs 60.3, p = 0.033). However, there was no significant difference in eGFR at 1 year or beyond, graft, and patient survival. The predictive value of combined dScr with ATI severity for DGF rate and DGF recovery time was superior to that of dScr alone. The predictive value of the combined DGF risk index with ATI severity for DGF was also better than that of the DGF risk index alone; however, the association of the DGF risk index with DGF recovery time was not identified. Chronic lesions including glomerulosclerosis, interstitial fibrosis, arterial intimal fibrosis, and arteriolar hyalinosis were associated with declined posttransplant 1-year eGFR.ConclusionBased on our pragmatic dichotomous grading criterion for ATI in a preimplantation biopsy, donor kidneys with severe ATI increased DGF risk, prolonged DGF recovery, and decreased short-term graft function but demonstrated favorable long-term graft function. Our grading method can offer additive valuable information for assessing donor kidneys with acute kidney injury and may act as an effective supplementary index of the Banff criteria.
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Affiliation(s)
- Jiali Wang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Jinqi Liu
- Department of Pediatrics, Guangzhou Women and Children’s Medical Centre, Guangzhou, China
| | - Wenrui Wu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shicong Yang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Longshan Liu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory on Organ Donation and Transplant Immunology, Guangzhou, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Qian Fu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xutao Chen
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ronghai Deng
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chenglin Wu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sizhe Long
- Center for Information Technology and Statistics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wujun Zhang
- Center for Information Technology and Statistics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huanxi Zhang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wenfang Chen, ; Haiping Mao, ; Huanxi Zhang,
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
- *Correspondence: Wenfang Chen, ; Haiping Mao, ; Huanxi Zhang,
| | - Wenfang Chen
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wenfang Chen, ; Haiping Mao, ; Huanxi Zhang,
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Bachmann Q, Haberfellner F, Büttner-Herold M, Torrez C, Haller B, Assfalg V, Renders L, Amann K, Heemann U, Schmaderer C, Kemmner S. The Kidney Donor Profile Index (KDPI) Correlates With Histopathologic Findings in Post-reperfusion Baseline Biopsies and Predicts Kidney Transplant Outcome. Front Med (Lausanne) 2022; 9:875206. [PMID: 35573025 PMCID: PMC9100560 DOI: 10.3389/fmed.2022.875206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background The increasing organ shortage in kidney transplantation leads to the necessity to use kidneys previously considered unsuitable for transplantation. Numerous studies illustrate the need for a better decision guidance rather than only the classification into kidneys from standard or expanded criteria donors referred to as SCD/ECD-classification. The kidney donor profile index (KDPI) exhibits a score utilizing a much higher number of donor characteristics. Moreover, graft biopsies provide an opportunity to assess organ quality. Methods In a single center analysis 383 kidney transplantations (277 after deceased and 106 after living donation) performed between January 1st, 2006, and December 31st, 2016, retrospectively underwent SCD/ECD and KDPI scoring. Thereby, the quality of deceased donor kidneys was assessed by using the KDPI and the living donor kidneys by using the living KDPI, in the further analysis merged as (L)KDPI. Baseline biopsies taken 10 min after the onset of reperfusion were reviewed for chronic and acute lesions. Survival analyses were performed using Kaplan-Meier analysis and Cox proportional hazards analysis within a 5-year follow-up. Results The (L)KDPI correlated with glomerulosclerosis (r = 0.30, p < 0.001), arteriosclerosis (r = 0.33, p < 0.001), interstitial fibrosis, and tubular atrophy (r = 0.28, p < 0.001) as well as the extent of acute tubular injury (r = 0.20, p < 0.001). The C-statistic of the (L)KDPI concerning 5-year death censored graft survival was 0.692. Around 48% of ECD-kidneys were classified as (L)KDPI<85%. In a multivariate Cox proportional hazard analysis including (preformed) panel reactive antibodies, cold ischemia time, (L)KDPI, and SCD/ECD-classification, the (L)KDPI was significantly associated with risk of graft loss (hazard ratio per 10% increase in (L)KDPI: 1.185, 95% confidence interval: 1.033–1.360, p = 0.025). Survival analysis revealed decreased death censored (p < 0.001) and non-death censored (p < 0.001) graft survival in kidneys with an increasing (L)KDPI divided into groups of <35, 35–85, and >85%, respectively. Conclusion With a higher granularity compared to the SCD/ECD-classification the (L)KDPI is a promising tool to judge graft quality. The correlation with chronic and acute histological lesions in post-reperfusion kidney biopsies underlines the descriptive value of the (L)KDPI. However, its prognostic value is limited and underlines the urgent need for a more precise prognostic tool adopted to European kidney transplant conditions.
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Affiliation(s)
- Quirin Bachmann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Flora Haberfellner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maike Büttner-Herold
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Carlos Torrez
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- School of Medicine, Institute of AI and Informatics in Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Volker Assfalg
- Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kerstin Amann
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- *Correspondence: Stephan Kemmner
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7
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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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8
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Zagni M, Croci GA, Cannavò A, Passamonti SM, De Feo T, Boggio FL, Cribiù FM, Maggioni M, Ferrero S, Gobbo AD, Gianelli U. Histological evaluation of ischaemic alterations in donors after cardiac death: A useful tool to predict post‐transplant renal function. Clin Transplant 2022; 36:e14622. [DOI: 10.1111/ctr.14622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Moreno Zagni
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Giorgio Alberto Croci
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation University of Milan Medical School Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Antonino Cannavò
- North Italy Transplant program (NITp) UOC Coordinamento Trapianti Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Serena Maria Passamonti
- North Italy Transplant program (NITp) UOC Coordinamento Trapianti Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Tullia De Feo
- North Italy Transplant program (NITp) UOC Coordinamento Trapianti Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Francesca Laura Boggio
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Fulvia Milena Cribiù
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Marco Maggioni
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Stefano Ferrero
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
- Department of Biomedical Surgical and Dental Sciences University of Milan Milan Italy
| | - Alessandro Del Gobbo
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
| | - Umberto Gianelli
- Division of Pathology Fondazione IRCCS Ca’ Granda ‐ Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation University of Milan Medical School Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milan Italy
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9
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Lerink LJS, de Kok MJC, Mulvey JF, Le Dévédec SE, Markovski AA, Wüst RCI, Alwayn IPJ, Ploeg RJ, Schaapherder AFM, Bakker JA, Lindeman JHN. Preclinical models versus clinical renal ischemia reperfusion injury: A systematic review based on metabolic signatures. Am J Transplant 2022; 22:344-370. [PMID: 34657378 PMCID: PMC9298342 DOI: 10.1111/ajt.16868] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 01/25/2023]
Abstract
Despite decennia of research and numerous successful interventions in the preclinical setting, renal ischemia reperfusion (IR) injury remains a major problem in clinical practice, pointing toward a translational gap. Recently, two clinical studies on renal IR injury (manifested either as acute kidney injury or as delayed graft function) identified metabolic derailment as a key driver of renal IR injury. It was reasoned that these unambiguous metabolic findings enable direct alignment of clinical with preclinical data, thereby providing the opportunity to elaborate potential translational hurdles between preclinical research and the clinical context. A systematic review of studies that reported metabolic data in the context of renal IR was performed according to the PRISMA guidelines. The search (December 2020) identified 35 heterogeneous preclinical studies. The applied methodologies were compared, and metabolic outcomes were semi-quantified and aligned with the clinical data. This review identifies profound methodological challenges, such as the definition of IR injury, the follow-up time, and sampling techniques, as well as shortcomings in the reported metabolic information. In light of these findings, recommendations are provided in order to improve the translatability of preclinical models of renal IR injury.
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Affiliation(s)
- Lente J. S. Lerink
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands,Transplant CenterLeiden University Medical CenterLeidenThe Netherlands
| | - Michèle J. C. de Kok
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands,Transplant CenterLeiden University Medical CenterLeidenThe Netherlands
| | - John F. Mulvey
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Sylvia E. Le Dévédec
- Department of Division of ToxicologyLeiden Academic Center for Drug ResearchLeiden UniversityLeidenThe Netherlands
| | | | - Rob C. I. Wüst
- Laboratory for MyologyFaculty of Behavioral and Movement SciencesAmsterdam Movement SciencesVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ian P. J. Alwayn
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands,Transplant CenterLeiden University Medical CenterLeidenThe Netherlands
| | - Rutger J. Ploeg
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands,Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Alexander F. M. Schaapherder
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands,Transplant CenterLeiden University Medical CenterLeidenThe Netherlands
| | - Jaap A. Bakker
- Department of Clinical ChemistryLeiden University Medical CenterLeidenThe Netherlands,Present address:
Laboratory Genetic Metabolic DiseasesAmsterdam Medical CenterAmsterdamThe Netherlands
| | - Jan H. N. Lindeman
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands,Transplant CenterLeiden University Medical CenterLeidenThe Netherlands
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10
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Passov A, Ilmakunnas M, Pihlajoki M, Hermunen K, Lempinen M, Helanterä I, Kailari V, Heikinheimo M, Andersson S, Pesonen E. Neutrophil gelatinase-associated lipocalin does not originate from the kidney during reperfusion in clinical renal transplantation. Intensive Care Med Exp 2021; 9:56. [PMID: 34807337 PMCID: PMC8608972 DOI: 10.1186/s40635-021-00422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 11/11/2021] [Indexed: 11/12/2022] Open
Abstract
Background Acute Kidney Injury (AKI) is a common clinical complication. Plasma/serum neutrophil gelatinase-associated lipocalin (NGAL) has been proposed as a rapid marker of AKI. However, NGAL is not kidney-specific. It exists in three isoforms (monomeric, homo-dimeric and hetero-dimeric). Only the monomeric isoform is produced by renal tubular cells and plasma NGAL levels are confounded by the release of all NGAL isoforms from neutrophils. Our aim was to investigate whether NGAL is released into blood from injured renal tubules. Methods Kidney transplantation (n = 28) served as a clinical model of renal ischaemic injury. We used ELISA to measure NGAL concentrations at 2 minutes after kidney graft reperfusion in simultaneously taken samples of renal arterial and renal venous blood. Trans-renal gradients (venous–arterial) of NGAL were calculated. We performed Western blotting to distinguish between renal and non-renal NGAL isoforms. Liver-type fatty acid binding protein (LFABP) and heart-type fatty acid binding protein (HFABP) served as positive controls of proximal and distal tubular damage. Results Significant renal release of LFABP [trans-renal gradient 8.4 (1.7–30.0) ng/ml, p = 0.005] and HFABP [trans-renal gradient 3.7 (1.1–5.0) ng/ml, p = 0.003] at 2 minutes after renal graft reperfusion indicated proximal and distal tubular damage. NGAL concentrations were comparable in renal venous and renal arterial blood. Thus, there was no trans-renal gradient of NGAL. Western blotting revealed that the renal NGAL isoform represented only 6% of the total NGAL in renal venous blood. Conclusions Ischaemic proximal and distal tubular damage occurs in kidney transplantation without concomitant NGAL washout from the kidney graft into blood. Plasma/serum NGAL levels are confounded by the release of NGAL from neutrophils. Present results do not support the interpretation that increase in plasma NGAL is caused by release from the renal tubules.
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Affiliation(s)
- Arie Passov
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PO BOX 266, 00029 HUS, Helsinki, Finland.
| | - Minna Ilmakunnas
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
| | - Marjut Pihlajoki
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PO BOX 347, FIN 00029 HUS, Helsinki, Finland
| | - Kethe Hermunen
- Transplantation and Liver Surgery Clinic, Abdominal Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
| | - Marko Lempinen
- Transplantation and Liver Surgery Clinic, Abdominal Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
| | - Ilkka Helanterä
- Transplantation and Liver Surgery Clinic, Abdominal Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
| | - Villemikko Kailari
- Faculty of Medicine, University of Helsinki, PO BOX 63, 00014, Helsinki, Finland
| | - Markku Heikinheimo
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PO BOX 347, FIN 00029 HUS, Helsinki, Finland.,Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, St. Louis, MO, 63110, USA
| | - Sture Andersson
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PO BOX 347, FIN 00029 HUS, Helsinki, Finland
| | - Eero Pesonen
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
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11
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Mohan S, Parikh CR. Underscoring the Case for Better Markers of Kidney Injury in Deceased Donors. Am J Kidney Dis 2021; 79:156-158. [PMID: 34742616 DOI: 10.1053/j.ajkd.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, New York; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Chirag R Parikh
- Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland.
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12
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Assfalg V, Misselwitz S, Renders L, Hüser N, Novotny A, Jäger C, Büttner-Herold M, Amann K, Schmaderer C, Heemann U, Wen M, Haberfellner F, Torrez C, Bachmann Q, Kemmner S. Kidney transplantation after rescue allocation-meticulous selection yields the chance for excellent outcome. Nephrol Dial Transplant 2021; 36:551-560. [PMID: 33367794 DOI: 10.1093/ndt/gfaa286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The small number of organ donors forces transplant centres to consider potentially suboptimal kidneys for transplantation. Eurotransplant established an algorithm for rescue allocation (RA) of kidneys repeatedly declined or not allocated within 5 h after procurement. Data on the outcomes and benefits of RA are scarce to date. METHODS We conducted a retrospective 8-year analysis of transplant outcomes of RA offers based on our in-house criteria catalogue for acceptance and decline of organs and potential recipients. RESULTS RA donors and recipients were both older compared with standard allocation (SA). RA donors more frequently had a history of hypertension, diabetes or fulfilled expanded criteria donor key parameters. RA recipients had poorer human leucocyte antigen (HLA) matches and longer cold ischaemia times (CITs). However, waiting time was shorter and delayed graft function, primary non-function and biopsy-proven rejections were comparable to SA. Five-year graft and patient survival after RA were similar to SA. In multivariate models accounting for confounding factors, graft survival and mortality after RA and SA were comparable as well. CONCLUSIONS Facing relevant comorbidities and rapid deterioration with the risk of being removed from the waiting list, kidney transplantation after RA was identified to allow for earlier transplantation with excellent outcome. Data from this survey propose not to reject categorically organs from multimorbid donors with older age and a history of hypertension or diabetes to aim for the best possible HLA matching and to carefully calculate overall expected CIT.
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Affiliation(s)
- Volker Assfalg
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Svea Misselwitz
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lutz Renders
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Novotny
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carsten Jäger
- Department of Surgery, Study Site for Clinical Research, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maike Büttner-Herold
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Kerstin Amann
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christoph Schmaderer
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Uwe Heemann
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ming Wen
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Flora Haberfellner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carlos Torrez
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Quirin Bachmann
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Kemmner
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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13
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Kulkarni S, Wei G, Jiang W, Lopez LA, Parikh CR, Hall IE. Outcomes From Right Versus Left Deceased-Donor Kidney Transplants: A US National Cohort Study. Am J Kidney Dis 2019; 75:725-735. [PMID: 31812448 DOI: 10.1053/j.ajkd.2019.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 08/10/2019] [Indexed: 12/11/2022]
Abstract
RATIONALE & OBJECTIVE There may be important transplant-related differences between right and left kidneys, including logistical/surgical considerations about vessel length for the right compared to the left kidney from the same donor. Because US centers choose between the right and left kidney when their recipient is ranked higher on a "match-run," we sought to determine whether deceased-donor right kidneys have had worse posttransplantation outcomes than left kidneys. STUDY DESIGN Paired Organ Procurement and Transplantation Network analysis. SETTING & PARTICIPANTS Deceased-donor kidney pairs transplanted during 1990 to 2016. EXPOSURE Right versus left kidney controlling for other significant factors. OUTCOMES Delayed graft function (DGF), all-cause and death-censored graft failure, and mortality. ANALYTICAL APPROACH Multivariable conditional logistic regression for DGF; proportional hazards models (conditional on same donor) for failure/mortality with right kidneys (operationalized as 6-month time-varying coefficients) adjusting for DGF and other confounders. RESULTS 87,112 recipient pairs shared the following donor characteristics: mean age of 41 ± 14 years, 60% males, and 11% with cardiac death. Recipient characteristics were numerically similar by donor kidney side but with some statistical differences given the sample size. Right kidneys had slightly longer cold ischemia time. DGF occurred more often for right kidneys (28% vs 25.8%; P < 0.001; adjusted OR, 1.15 [95% CI, 1.12-1.17]). The adjusted hazard ratio (aHR) for all-cause graft failure with right kidneys within 6 months was 1.07 (95% CI, 1.03-1.11), and was 0.99 (95% CI, 0.97-1.01) thereafter. The aHRs for death-censored graft failure with right kidneys before and after 6 months were 1.11 (95% CI, 1.06-1.16) and 0.96 (95% CI, 0.93-0.99), respectively; the corresonding aHRs for mortality were 0.99 (95% CI, 0.93-1.04) and 1.00 (95% CI, 0.98-1.03), respectively. LIMITATIONS Registry data, different transplant eras, reasons for kidney side unavailable. CONCLUSIONS There is modest association for transplantation of right kidneys with DGF and graft loss within the first 6 months, which is lost beyond this time point. These findings do not support the use of laterality of deceased-donor kidneys as an important factor in organ acceptance decisions.
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Affiliation(s)
- Sanjay Kulkarni
- Section of Organ Transplantation and Immunology, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Guo Wei
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Wei Jiang
- Yale University Graduate School of Arts and Sciences, New Haven, CT
| | - Licia A Lopez
- Department of Pediatrics, Native American Research Internship, University of Utah School of Medicine, Salt Lake City, UT
| | - Chirag R Parikh
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Isaac E Hall
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT.
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14
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Hu XJ, Zheng J, Li Y, Tian XH, Tian PX, Xiang HL, Pan XM, Ding CG, Ding XM, Xue WJ. Prediction of kidney transplant outcome based on different DGF definitions in Chinese deceased donation. BMC Nephrol 2019; 20:409. [PMID: 31722677 PMCID: PMC6854725 DOI: 10.1186/s12882-019-1557-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/09/2019] [Indexed: 12/03/2022] Open
Abstract
Background Delayed graft function (DGF) is an important complication of kidney transplantation and can be diagnosed according to different definitions. DGF has been suggested to be associated with the long-term outcome of kidney transplantation surgery. However, the best DGF definition for predicting renal transplant outcomes in Chinese donations after cardiac death (DCDs) remains to be determined. Method A total of 372 DCD kidney transplant recipients from June 2013 to July 2017 in the First Affiliated Hospital of Xi’an Jiaotong University were included in this retrospective study to compare 6 different DGF definitions. The relationships of the DGF definitions with transplant outcome were analyzed, including graft loss (GL) and death-censored graft loss (death-censored GL). Renal function indicators, including one-year estimated glomerular filtration rate (eGFR) and three-year eGFR, and were compared between different DGF groups. Results The incidence of DGF varied from 4.19 to 35.22% according to the different DGF diagnoses. All DGF definitions were significantly associated with three-year GL as well as death-censored GL. DGF based on requirement of hemodialysis within the first week had the best predictive value for GL (AUC 0.77), and DGF based on sCr variation during the first 3 days post-transplant had the best predictive value for three-year death-censored GL (AUC 0.79). Combination of the 48-h sCr reduction ratio and classical DGF can improve the AUC for GL (AUC 0.85) as well as the predictive accuracy for death-censored GL (83.3%). Conclusion DGF was an independent risk factor for poor transplant outcome. The combination of need for hemodialysis within the first week and the 48-h serum creatinine reduction rate has a better predictive value for patient and poor graft outcome.
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Affiliation(s)
- Xiao-Jun Hu
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jin Zheng
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yang Li
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xiao-Hui Tian
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Pu-Xun Tian
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - He-Li Xiang
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xiao-Ming Pan
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Chen-Guang Ding
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xiao-Ming Ding
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Wu-Jun Xue
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. .,Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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15
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Lentine KL, Naik AS, Schnitzler MA, Randall H, Wellen JR, Kasiske BL, Marklin G, Brockmeier D, Cooper M, Xiao H, Zhang Z, Gaston RS, Rothweiler R, Axelrod DA. Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation. Am J Transplant 2019; 19:2241-2251. [PMID: 30809941 DOI: 10.1111/ajt.15325] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/30/2019] [Accepted: 02/19/2019] [Indexed: 01/25/2023]
Abstract
The use of procurement biopsies in deceased donor kidney acceptance is controversial. We analyzed Scientific Registry of Transplant Recipients data (n = 59 328 allografts, 2014-2018) to describe biopsy practices across US organ procurement organizations (OPOs) and examine relationships with discards, using hierarchical modeling to account for OPO and donor factors. Median odds ratios (MORs) provide the median of the odds that allografts with identical reported traits would be biopsied or discarded from 2 randomly drawn OPOs. Biopsies were obtained for 52.7% of kidneys. Biopsy use rose in a graded manner with kidney donor profile index (KDPI). Biopsy rates differed significantly among OPOs (22.8% to 77.5%), even after adjustment for KDPI and other donor factors. Discard rates also varied from 6.6% to 32.1% across OPOs. After adjustment for donor factors and OPO, biopsy was associated with more than 3 times the likelihood of discard (adjusted odds ratio [95%LCL aOR95%UCL ], 3.29 3.513.76 ). This association was most pronounced for low-risk (KDPI <20) kidneys (aOR, 5.45 6.477.69 ), with minimal impact at KDPI >85 (aOR, 0.88 1.151.51 ). Adjusted MORs for kidney discard and biopsy were greatest for low-risk kidneys. Reducing the rate of unnecessary biopsy and improving the accuracy of histologic assessments in higher KDPI organs may help reduce graft discard rates.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Abhijit S Naik
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mark A Schnitzler
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Henry Randall
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Jason R Wellen
- Transplant Surgery, Department of Surgery, Washington University, St. Louis, Missouri
| | | | | | | | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington, District of Columbia
| | - Huiling Xiao
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Zidong Zhang
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
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16
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van Smaalen TC, Ellis SR, Mascini NE, Siegel TP, Cillero-Pastor B, Hillen LM, van Heurn LWE, Peutz-Kootstra CJ, Heeren RMA. Rapid Identification of Ischemic Injury in Renal Tissue by Mass-Spectrometry Imaging. Anal Chem 2019; 91:3575-3581. [PMID: 30702282 PMCID: PMC6581420 DOI: 10.1021/acs.analchem.8b05521] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/31/2019] [Indexed: 12/14/2022]
Abstract
The increasing analytical speed of mass-spectrometry imaging (MSI) has led to growing interest in the medical field. Acute kidney injury is a severe disease with high morbidity and mortality. No reliable cut-offs are known to estimate the severity of acute kidney injury. Thus, there is a need for new tools to rapidly and accurately assess acute ischemia, which is of clinical importance in intensive care and in kidney transplantation. We investigated the value of MSI to assess acute ischemic kidney tissue in a porcine model. A perfusion model was developed where paired kidneys received warm (severe) or cold (minor) ischemia ( n = 8 per group). First, ischemic tissue damage was systematically assessed by two blinded pathologists. Second, MALDI-MSI of kidney tissues was performed to study the spatial distributions and compositions of lipids in the tissues. Histopathological examination revealed no significant difference between kidneys, whereas MALDI-MSI was capable of a detailed discrimination of severe and mild ischemia by differential expression of characteristic lipid-degradation products throughout the tissue within 2 h. In particular, lysolipids, including lysocardiolipins, lysophosphatidylcholines, and lysophosphatidylinositol, were dramatically elevated after severe ischemia. This study demonstrates the significant potential of MSI to differentiate and identify molecular patterns of early ischemic injury in a clinically acceptable time frame. The observed changes highlight the underlying biochemical processes of acute ischemic kidney injury and provide a molecular classification tool that can be deployed in assessment of acute ischemic kidney injury.
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Affiliation(s)
- T. C. van Smaalen
- Department
of Surgery, Maastricht University Medical
Center+, 6229 HX Maastricht, The Netherlands
| | - S. R. Ellis
- The
Maastricht Multimodal Molecular Imaging Institute (M4I), Division
of Imaging Mass Spectrometry, Maastricht
University, 6200 MD Maastricht, The Netherlands
| | - N. E. Mascini
- The
Maastricht Multimodal Molecular Imaging Institute (M4I), Division
of Imaging Mass Spectrometry, Maastricht
University, 6200 MD Maastricht, The Netherlands
| | - T. Porta Siegel
- The
Maastricht Multimodal Molecular Imaging Institute (M4I), Division
of Imaging Mass Spectrometry, Maastricht
University, 6200 MD Maastricht, The Netherlands
| | - B. Cillero-Pastor
- The
Maastricht Multimodal Molecular Imaging Institute (M4I), Division
of Imaging Mass Spectrometry, Maastricht
University, 6200 MD Maastricht, The Netherlands
| | - L. M. Hillen
- Department
of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
- GROW-School
for Oncology and Developmental Biology, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - L. W. E. van Heurn
- Department
of Surgery, Maastricht University Medical
Center+, 6229 HX Maastricht, The Netherlands
| | - C. J. Peutz-Kootstra
- Department
of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - R. M. A. Heeren
- The
Maastricht Multimodal Molecular Imaging Institute (M4I), Division
of Imaging Mass Spectrometry, Maastricht
University, 6200 MD Maastricht, The Netherlands
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17
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Pieters TT, Falke LL, Nguyen TQ, Verhaar MC, Florquin S, Bemelman FJ, Kers J, Vanhove T, Kuypers D, Goldschmeding R, Rookmaaker MB. Histological characteristics of Acute Tubular Injury during Delayed Graft Function predict renal function after renal transplantation. Physiol Rep 2019; 7:e14000. [PMID: 30821122 PMCID: PMC6395310 DOI: 10.14814/phy2.14000] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 12/11/2022] Open
Abstract
Acute Tubular Injury (ATI) is the leading cause of Delayed Graft Function (DGF) after renal transplantation (RTX). Biopsies taken 1 week after RTX often show extensive tubular damage, which in most cases resolves due to the high regenerative capacity of the kidney. Not much is known about the relation between histological parameters of renal damage and regeneration immediately after RTX and renal outcome in patients with DGF. We retrospectively evaluated 94 patients with DGF due to ATI only. Biopsies were scored for morphological characteristics of renal damage (edema, casts, vacuolization, and dilatation) by three independent blinded observers. The regenerative potential was quantified by tubular cells expressing markers of proliferation (Ki67) and dedifferentiation (CD133). Parameters were related to renal function after recovery (CKD-EPI 3, 6, and 12 months posttransplantation). Quantification of morphological characteristics was reproducible among observers (Kendall's W ≥ 0.56). In a linear mixed model, edema and casts significantly associated with eGFR within the first year independently of clinical characteristics. Combined with donor age, edema and casts outperformed the Nyberg score, a well-validated clinical score to predict eGFR within the first year after transplantation (R2 = 0.29 vs. R2 = 0.14). Although the number of Ki67+ cells correlated to the extent of acute damage, neither CD133 nor Ki67 correlated with renal functional recovery. In conclusion, the morphological characteristics of ATI immediately after RTX correlate with graft function after DGF. Despite the crucial role of regeneration in recovery after ATI, we did not find a correlation between dedifferentiation marker CD133 or proliferation marker Ki67 and renal recovery after DGF.
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Affiliation(s)
- Tobias T. Pieters
- Department of Nephrology and HypertensionUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Lucas L. Falke
- Department of PathologyUniversity Medical Center UtrechtUtrechtThe Netherlands
- Department of Internal MedicineDiakonessenhuisUtrechtThe Netherlands
| | - Tri Q. Nguyen
- Department of PathologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and HypertensionUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Sandrine Florquin
- Department of PathologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Frederike J. Bemelman
- Department of NephrologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Jesper Kers
- Department of PathologyAmsterdam University Medical CentersAmsterdamThe Netherlands
- University of AmsterdamVan ‘t Hoff Institute for Molecular Sciences (HIMS)AmsterdamThe Netherlands
| | - Thomas Vanhove
- Department of NephrologyUniversity Hospitals of LeuvenLeuvenBelgium
| | - Dirk Kuypers
- Department of NephrologyUniversity Hospitals of LeuvenLeuvenBelgium
| | - Roel Goldschmeding
- Department of PathologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Maarten B. Rookmaaker
- Department of Nephrology and HypertensionUniversity Medical Center UtrechtUtrechtThe Netherlands
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18
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Cima L, Nacchia F, Ghimenton C, Valotto G, Boschiero L, Gobbo S, Zaza G, Neil D, Mescoli C, Vanzo F, D’Errico A, Ghimenton C, Rugge M, Casartelli-Liviero M, Brunelli M, Novelli L, Eccher A. Histopathology and Long-Term Outcome of Kidneys Transplanted From Donors With Severe Acute Kidney Injury. Prog Transplant 2019; 29:36-42. [DOI: 10.1177/1526924818817054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background: Acute kidney injury is a treatable entity although difficult to recognize without diagnostic biopsy. We investigated the potential association between clinically defined deceased donors and acute kidney injury with preimplantation histological findings and recipient outcomes. Methods: Kidney biopsies from donors were classified using the Acute Kidney Injury Network criteria and assessed for percentage glomerulosclerosis, tubular atrophy, interstitial fibrosis, and vascular narrowing with the Remuzzi score and for acute tubular necrosis. Differences in incidence rates of delayed graft function (DGF) and cumulative rejection episodes were compared between recipients transplanted with normal and 3 levels of acute kidney injury using the analysis of variance with Bonferroni correction ( P = .0012). Results: Sixteen out of 335 donors showed a severe acute kidney injury level 3 with a median serum creatinine of 458 µmol/L. Fourteen (88%) had 0-3 Remuzzi score and were used for single kidney transplantation and 2 (12%) were used for dual kidney transplantation (score: 4-6). Recipients who received a kidney from a donor with level 3 acute kidney injury had a higher percentage of DGF (47%) without statistical significance ( P = .008). The rate of cumulative rejection (45%) at 2 years was not significantly increased ( P = .09). Conclusions: Recipients receiving level 3 acute kidney injury kidneys, selected with Remuzzi histopathological score and acute tubular necrosis assessment, had a greater incidence of DGF but a similar long-term cumulative rejection compared to no injury and level 1 and level 2 acute kidney injury donors. The application of the histopathological examination allowed expansion of the kidney donor pool.
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Affiliation(s)
- Luca Cima
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Francesco Nacchia
- Department of Surgical Sciences, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Ghimenton
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Valotto
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Luigino Boschiero
- Department of Surgical Sciences, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Gobbo
- Pathology Unit, Pederzoli Hospital of Peschiera Del Garda, Verona, Italy
| | - Gianluigi Zaza
- Department of Medicine, Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Desley Neil
- Department of Histopathology, Pathology Unit, Queen Elizabeth Hospital Birmingham, England
| | - Claudia Mescoli
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University and Hospital Trust of Padua, Padua, Italy
| | - Francesca Vanzo
- Arsenàl, Veneto’s Research Center for eHealth Innovation, Veneto, Italy
| | - Antonietta D’Errico
- Department of Specialised, Experimental and Diagnostic Medicine, Pathology Unit, Sant’Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Massimo Rugge
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University and Hospital Trust of Padua, Padua, Italy
| | - Marilena Casartelli-Liviero
- Department of Surgical Sciences, Neurosurgery and Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Novelli
- Pathology Unit, Carreggi University Hospital, Firenze, Italy
| | - Albino Eccher
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Verona, Italy
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19
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Garrouste C, Baudenon J, Gatault P, Pereira B, Etienne I, Thierry A, Szlavik N, Aniort J, Rabant M, Lambert C, Sayegh J, Oniszczuk J, Anglicheau D, Heng AE. No impact of disseminated intravascular coagulation in kidney donors on long-term kidney transplantation outcome: A multicenter propensity-matched study. Am J Transplant 2019; 19:448-456. [PMID: 29981217 DOI: 10.1111/ajt.15008] [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] [Received: 12/08/2017] [Revised: 06/14/2018] [Accepted: 06/24/2018] [Indexed: 01/25/2023]
Abstract
The diagnosis of disseminated intravascular coagulation (DIC) is often considered to be a contraindication to organ donation. The aim of this study was to evaluate the impact of DIC+ donors on kidney recipient (KR) evolution. We identified 169 KRs with DIC+ donation after brain death donors between January 1996 and December 2012 in 6 French transplant centers. Individuals were matched using propensity scores to 338 recipients with DIC- donors according to donor age and sex, whether expanded criteria for the donor existed, graft year, and transplantation center. After kidney transplantation, delayed graft function was observed in 28.1% of DIC+ KRs and in 22.8% of DIC- KRs (NS). Renal allograft survival at 1, 5, and 10 years was 94.5%, 89.3%, and 73.9% and 96.2%, 90.8%, and 81.3% in DIC+ KRs and DIC- KRs, respectively (NS). The median estimated glomerular filtration rate (eGFR) was similar between DIC+ and DIC- KRs at 3 months, 1 year, and 10 years: 45.9 vs 48.1 mL/min, 42.1 vs 43.1 mL/min, and 33.9 vs 38.1 mL/min, respectively. Delayed calcineurin inhibitor introduction or induction had no impact on delayed graft function rate or eGFR evolution at 10 years after transplantation in DIC+ KRs. Donor DIC did not seem to affect initial outcome, long-term graft function, or allograft survival.
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Affiliation(s)
- Cyril Garrouste
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Julien Baudenon
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Philippe Gatault
- Department of Nephrology and Clinical Immunology, CHRU de Tours, Tours, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Antoine Thierry
- Department of Nephrology Dialysis and Kidney Transplantation, CHU de Poitiers, Poitiers, France
| | - Nora Szlavik
- Pathology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Julien Aniort
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Marion Rabant
- Pathology Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Céline Lambert
- Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Johnny Sayegh
- Department of Nephrology Dialysis and Kidney Transplantation, CHU d' Angers, Angers, France
| | - Julie Oniszczuk
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Elisabeth Heng
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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20
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Carpenter D, Husain SA, Brennan C, Batal I, Hall IE, Santoriello D, Rosen R, Crew RJ, Campenot E, Dube GK, Radhakrishnan J, Stokes MB, Sandoval PR, D’Agati V, Cohen DJ, Ratner LE, Markowitz G, Mohan S. Procurement Biopsies in the Evaluation of Deceased Donor Kidneys. Clin J Am Soc Nephrol 2018; 13:1876-1885. [PMID: 30361336 PMCID: PMC6302333 DOI: 10.2215/cjn.04150418] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 09/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Biopsies taken at deceased donor kidney procurement continue to be cited as a leading reason for discard; however, the reproducibility and prognostic capability of these biopsies are controversial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We compiled a retrospective, single-institution, continuous cohort of deceased donor kidney transplants performed from 2006 to 2009. Procurement biopsy information-percentage of glomerulosclerosis, interstitial fibrosis/tubular atrophy, and vascular disease-was obtained from the national transplant database. Using univariable, multivariable, and time-to-event analyses for death-censored graft survival, we compared procurement frozen section biopsy reports with reperfusion paraffin-embedded biopsies read by trained kidney pathologists (n=270). We also examined agreement for sequential procurement biopsies performed on the same kidney (n=116 kidneys). RESULTS For kidneys on which more than one procurement biopsy was performed (n=116), category agreement was found in only 64% of cases (κ=0.14). For all kidneys (n=270), correlation between procurement and reperfusion biopsies was poor: overall, biopsies were classified into the same category (optimal versus suboptimal) in only 64% of cases (κ=0.25). This discrepancy was most pronounced when categorizing percentage of glomerulosclerosis, which had 63% agreement (κ=0.15). Interstitial fibrosis/tubular atrophy and vascular disease had agreement rates of 82% (κ=0.13) and 80% (κ=0.15), respectively. Ninety-eight (36%) recipients died, and 56 (21%) allografts failed by the end of follow-up. Reperfusion biopsies were more prognostic than procurement biopsies (hazard ratio for graft failure, 2.02; 95% confidence interval, 1.09 to 3.74 versus hazard ratio for graft failure, 1.30; 95% confidence interval, 0.61 to 2.76), with procurement biopsies not significantly associated with graft failure. CONCLUSIONS We found that procurement biopsies are poorly reproducible, do not correlate well with paraffin-embedded reperfusion biopsies, and are not significantly associated with transplant outcomes.
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Affiliation(s)
| | - S. Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- The Columbia University Renal Epidemiology Group, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Corey Brennan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and
| | | | - Isaac E. Hall
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Dominick Santoriello
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Raphael Rosen
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - R. John Crew
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Geoffrey K. Dube
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | | | - David J. Cohen
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- The Columbia University Renal Epidemiology Group, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and
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21
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Favi E, Puliatti C, Iesari S, Monaco A, Ferraresso M, Cacciola R. Impact of Donor Age on Clinical Outcomes of Primary Single Kidney Transplantation From Maastricht Category-III Donors After Circulatory Death. Transplant Direct 2018; 4:e396. [PMID: 30498772 PMCID: PMC6233668 DOI: 10.1097/txd.0000000000000835] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/11/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Standard-criteria donation after circulatory death (DCD) kidney transplants (KTx) have higher primary nonfunction, delayed graft function (DGF), and rejection rates than age-matched donation after brain death (DBD) but similar graft survival. Data on expanded-criteria DCD are conflicting and many centers remain concerned regarding their use. METHODS In this single-center observational study with 5-year follow-up, we analyzed data from 112 primary DCD Maastricht category-III single KTx receiving similar organ preservation and maintenance immunosuppression. Patients were sorted as young DCD (donor <60 years, 72 recipients) or old DCD (donor ≥60 years, 40 recipients). Old DCD outcomes were compared with young DCD and to a DBD control group (old DBD, donor ≥60 years, 40 recipients). RESULTS After 5 years, old DCD showed lower patient survival (66% vs 85%; P = 0.014), death-censored graft survival (63% vs 83%; P = 0.001), and Modification of Diet in Renal Disease estimated glomerular filtration rate (34, 27.0-42.0 mL/min per 1.73 m2 vs 45.0, 33.0-58.0 mL/min per 1.73 m2; P = 0.021) than young DCD with higher DGF (70% vs 47.2%; P = 0.029) and graft thrombosis (12.5% vs 1.4%; P = 0.021). Comparison between old DCD and old DBD showed similar 5-year patient survival (66% vs 67%; P = 0.394) and death-censored graft survival (63% vs 69%; P = 0.518) but higher DGF (70% vs 37.5%; P = 0.007) and lower estimated glomerular filtration rate (34, 27.0-42.0 mL/min per 1.73 m2 vs 41, 40.0-42.0 mL/min per 1.73 m2; P = 0.029). Multivariate Cox regression analysis showed that donor 60 years or older (hazard ratio, 3.135; 95% confidence interval, 1.716-5.729; P < 0.001) and induction with anti-IL2-receptor-α monoclonal antibody (hazard ratio, 0.503; 95% confidence interval, 0.269-0.940, P = 0.031 in favor of induction with rabbit antithymocyte globulin) are independent predictors of transplant loss. CONCLUSIONS Overall, single KTx from DCD Maastricht category-III donors 60 years or older have inferior outcomes than KTx from donors younger than 60 years. Comparison with age-matched DBD showed similar patient and graft survivals. However, the discrepancy in graft function between DCD and DBD deserves further investigation.
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Affiliation(s)
- Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carmelo Puliatti
- Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
| | - Samuele Iesari
- Organ Transplantation, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea Monaco
- Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
| | - Mariano Ferraresso
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Roberto Cacciola
- Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
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22
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Hall IE, Parikh CR, Schröppel B, Weng FL, Jia Y, Thiessen-Philbrook H, Reese PP, Doshi MD. Procurement Biopsy Findings Versus Kidney Donor Risk Index for Predicting Renal Allograft Survival. Transplant Direct 2018; 4:e373. [PMID: 30255133 PMCID: PMC6092182 DOI: 10.1097/txd.0000000000000816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/18/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Efforts to maximize transplantation by matching organ quality to recipient longevity require reliable tools. The US kidney allocation system uses the Kidney Donor Risk Index (KDRI) for this purpose, and many centers additionally rely on donor biopsies. The Leuven score combines donor age with procurement histology (glomerulosclerosis and interstitial fibrosis/tubular atrophy) to predict allograft survival. METHODS We compared KDRI with Leuven scores for associations with kidney discard, delayed graft function, and allograft function and survival. We used Cox, modified Poisson, and linear regression to calculate risks based on KDRI and (separately) Leuven scores, adjusting for important transplant and recipient variables. RESULTS From 890 donors, 1729 kidneys were procured and biopsied. Five hundred eighty-five (34%) kidneys were discarded. Median donor age was 53 years (interquartile range [IQR], 44-61 years). Median KDRI and Leuven scores were 1.56 (IQR, 1.28-1.90) and 59 (IQR, 49-69). Relative risk for discard was 1.21 (95% confidence interval [CI], 1.17-1.24) per 0.2-unit increase in KDRI and 1.38 (1.31-1.46) per 10-unit increase in Leuven score. Adjusted relative risks for delayed graft function were 0.98 (95% CI, 0.94-1.02) and 0.94 (95% CI, 0.90-0.99), adjusted hazard ratios for graft failure were 1.10 (95% CI, 1.04-1.16) and 1.11 (95% CI, 1.02-1.21), and adjusted linear regression coefficients for 3-year estimated glomerular filtration rate were -3.88 (-4.63 to -3.13) and -5.18 (-6.19 to -4.18). CONCLUSIONS In kidneys clinically selected for procurement biopsy, the Leuven score was more strongly associated with discard but performed similarly to KDRI for predicting transplant outcomes, suggesting the need to reevaluate current procurement biopsy practices. Given modest associations for both tools; however, neither KDRI nor the Leuven score should be used in isolation for individual organ acceptance decisions.
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Affiliation(s)
- Isaac E. Hall
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Chirag R. Parikh
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT
- Veterans Affairs Connecticut Healthcare System, New Haven, CT
| | | | | | - Yaqi Jia
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT
| | | | - Peter P. Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA
| | - Mona D. Doshi
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
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23
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Traynor C, Saeed A, O'Ceallaigh E, Elbadri A, O'Kelly P, de Freitas DG, Dorman AM, Conlon PJ, O'Seaghdha CM. Pre-transplant histology does not improve prediction of 5-year kidney allograft outcomes above and beyond clinical parameters. Ren Fail 2018; 39:671-677. [PMID: 28832239 PMCID: PMC6446141 DOI: 10.1080/0886022x.2017.1363778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Pre-implant kidney biopsy is used to determine suitability of marginal donor kidneys for transplantation. However, there is limited data examining the utility of pre-implant histology in predicting medium term graft outcome. This retrospective study examined kidney transplants over a 10-year period at a single center to determine if pre-implant histology can identify cases of eGFR ≤35 ml/min/1.73m2 at 5 year follow up beyond a clinical predictive logistic regression model. We also compared outcomes of dual kidney transplants with standard single kidney transplants. Of 1195 transplants, 171 received a pre-implant kidney biopsy and 15 were dual transplants. There was no significant difference in graft and patient survival rates. Median eGFR was lower in recipients of biopsied kidneys compared with standard kidney transplants (44 vs. 54 ml/min/1.73m2, p < .001). Median eGFR of dual transplant and standard kidney transplants were similar (58 vs. 54 ml/min/1.73m2, p = .64). Glomerular sclerosis (p = .05) and Karpinski Score (p = .03) were significant predictors of eGFR at 5-years in multivariate analysis but did not improve discrimination of eGFR ≤35 ml/min/1.73m2 at 5-years beyond a clinical prediction model comprising donor age, donor hypertension and terminal donor creatinine (C-statistic 0.67 vs. 0.66; p = .647). Pre-implant histology did not improve prediction of medium-term graft outcomes beyond clinical predictors alone. Allograft function of dual transplant kidneys was similar to standard transplants, suggesting that there is scope to increase utilization of kidneys considered marginal based on histology.
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Affiliation(s)
- C Traynor
- a Department of Nephrology and Transplantation , Beaumont Hospital , Dublin , Ireland
| | - A Saeed
- b Royal College of Surgeons , Dublin , Ireland
| | | | - A Elbadri
- a Department of Nephrology and Transplantation , Beaumont Hospital , Dublin , Ireland
| | - P O'Kelly
- a Department of Nephrology and Transplantation , Beaumont Hospital , Dublin , Ireland
| | - D G de Freitas
- a Department of Nephrology and Transplantation , Beaumont Hospital , Dublin , Ireland
| | - A M Dorman
- c Department of Pathology , Beaumont Hospital , Dublin , Ireland
| | - P J Conlon
- a Department of Nephrology and Transplantation , Beaumont Hospital , Dublin , Ireland
| | - C M O'Seaghdha
- a Department of Nephrology and Transplantation , Beaumont Hospital , Dublin , Ireland
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24
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Mohan S, Chiles MC, Patzer RE, Pastan SO, Husain SA, Carpenter DJ, Dube GK, Crew RJ, Ratner LE, Cohen DJ. Factors leading to the discard of deceased donor kidneys in the United States. Kidney Int 2018; 94:187-198. [PMID: 29735310 PMCID: PMC6015528 DOI: 10.1016/j.kint.2018.02.016] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 01/22/2023]
Abstract
The proportion of deceased donor kidneys procured for transplant but subsequently discarded has been growing steadily in the United States, but factors contributing to the rising discard rate remain unclear. To assess the reasons for and probability of organ discard we assembled a cohort of 212,305 deceased donor kidneys recovered for transplant from 2000-2015 in the SRTR registry that included 36,700 kidneys that were discarded. 'Biopsy Findings' (38.2%) was the most commonly reported reason for discard. The median Kidney Donor Risk Index of discarded kidneys was significantly higher than transplanted organs (1.78 vs 1.12), but a large overlap in the quality of discarded and transplanted kidneys was observed. Kidneys of donors who were older, female, Black, obese, diabetic, hypertensive or HCV-positive experienced a significantly increased odds of discard. Kidneys from donors with multiple unfavorable characteristics were more likely to be discarded, whereas unilaterally discarded kidneys had the most desirable donor characteristics and the recipients of their partner kidneys experienced a one-year death-censored graft survival rate over 90%. There was considerable geographic variation in the odds of discard across the United States, which further supports the notion that factors beyond organ quality contributed to kidney discard. Thus, while the discard of a small fraction of organs procured from donors may be inevitable, the discard of potentially transplantable kidneys needs to be avoided. This will require a better understanding of the factors contributing to organ discard in order to remove the disincentives to utilize less-than-ideal organs for transplantation.
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Affiliation(s)
- Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA; The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA.
| | - Mariana C Chiles
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA; The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
| | - Rachel E Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Stephen O Pastan
- Department of Medicine, Renal Division, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA
| | - S Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA; The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
| | - Dustin J Carpenter
- Department of Surgery, Division of Transplantation, Columbia University Medical Center, New York, New York, USA
| | - Geoffrey K Dube
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA
| | - R John Crew
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA
| | - Lloyd E Ratner
- Department of Surgery, Division of Transplantation, Columbia University Medical Center, New York, New York, USA
| | - David J Cohen
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA
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25
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Schmitt FCF, Salgado E, Friebe J, Schmoch T, Uhle F, Fleming T, Zemva J, Kihm L, Nusshag C, Morath C, Zeier M, Bruckner T, Mehrabi A, Nawroth PP, Weigand MA, Hofer S, Brenner T. Cell cycle arrest and cell death correlate with the extent of ischaemia and reperfusion injury in patients following kidney transplantation - results of an observational pilot study. Transpl Int 2018; 31:751-760. [PMID: 29505681 DOI: 10.1111/tri.13148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 06/26/2017] [Accepted: 02/28/2018] [Indexed: 01/11/2023]
Abstract
A prolonged cold ischaemia time (CIT) is suspected to be associated with an increased ischaemia and reperfusion injury (IRI) resulting in an increased damage to the graft. In total, 91 patients were evaluated for a delayed graft function within 7 days after kidney transplantation (48 deceased, 43 living donors). Blood and urine samples were collected before, immediately after the operation, and 1, 3, 5, 7 and 10 days later. Plasma and/or urine levels of total keratin 18 (total K18), caspase-cleaved keratin 18 (cc K18), the soluble receptor for advanced glycation end products (sRAGE), tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein-7 (IGFBP7) were measured. As a result of prolonged CIT and increased IRI, deceased donor transplantations were shown to suffer from a more distinct cell cycle arrest and necrotic cell death. Plasmatic total K18 and urinary TIMP-2 and IGFBP7 were therefore demonstrated to be of value for the detection of a delayed graft function (DGF), as they improved the diagnostic performance of a routinely used clinical scoring system. Plasmatic total K18 and urinary TIMP-2 and IGFBP7 measurements are potentially suitable for early identification of patients at high risk for a DGF following kidney transplantation from deceased or living donors.
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Affiliation(s)
- Felix C F Schmitt
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Eduardo Salgado
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Janina Friebe
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Schmoch
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Uhle
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Fleming
- Department of Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Johanna Zemva
- Department of Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Lars Kihm
- Department of Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Nusshag
- Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter P Nawroth
- Department of Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany.,Joint Division Molecular Metabolic Control, German Cancer Research Center (DKFZ) Heidelberg Center for Molecular Biology (ZMBH) and University Hospital Heidelberg University, Heidelberg, Germany Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Neuherberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Hofer
- Department of Anesthesiology, Kaiserslautern Westpfalz Hospital, Kaiserslautern, Germany
| | - Thorsten Brenner
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
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26
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Single Graft Utilization From Donors With Severe Acute Kidney Injury After Circulatory Death. Transplant Direct 2018; 4:e355. [PMID: 29707626 PMCID: PMC5908460 DOI: 10.1097/txd.0000000000000768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/29/2017] [Indexed: 12/21/2022] Open
Abstract
Chronic shortages of organs for transplantation have led to the use of marginal kidneys from donors after circulatory death with acute kidney injury (AKI), but the utilization of kidneys with severe AKI is not well established. We retrospectively analyzed eight kidney transplantation (KTx) cases from donation after circulatory death (DCD) with terminal creatinine (t-Cr) concentrations higher than 10.0 mg/dL and/or oliguria for more than 5 days (AKI network criteria: stage III). Although all patients showed delayed graft function, no cases of primary nonfunction (PNF) were found. Five patients maintained stable renal function for approximately 15.5, 10, 10, 5, and 0.5 years after KTx. Only 1 patient showed biopsy-proven acute rejection. Also, 2 patients developed graft failure: one attributable to chronic antibody mediated rejection at 11.3 years after KTx, and one attributable to recurrence of IgA nephropathy at 4.6 years after KTx. Kidneys with AKI stage III yielded great outcomes without the risk of primary nonfunction and rejection. Although the AKI kidneys were associated with delayed graft function, these results suggest that even the most severe kidneys with AKI stage III from DCD donors can be considered a valid alternative for recipients on a waiting list for KTx.
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27
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Fortarezza F, Serio G, Rossini M, Rossi R, Fiore G, Piscitelli D, Battaglia M, Gesualdo L, Resta L. To do or not to do kidney biopsy in pediatric donors to evaluate transplant eligibility? Pediatr Transplant 2017; 21. [PMID: 29057551 DOI: 10.1111/petr.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- F Fortarezza
- Department of Emergency and Organ Transplantation (DETO), Pathology Division, Medical School, University of Bari, Bari, Italy
| | - G Serio
- Department of Emergency and Organ Transplantation (DETO), Pathology Division, Medical School, University of Bari, Bari, Italy
| | - M Rossini
- Department of Emergency and Organ Transplantation (DETO), Nephrology Division, Medical School, University of Bari, Bari, Italy
| | - R Rossi
- Department of Emergency and Organ Transplantation (DETO), Pathology Division, Medical School, University of Bari, Bari, Italy
| | - G Fiore
- Department of Emergency and Organ Transplantation (DETO), Pathology Division, Medical School, University of Bari, Bari, Italy
| | - D Piscitelli
- Department of Emergency and Organ Transplantation (DETO), Pathology Division, Medical School, University of Bari, Bari, Italy
| | - M Battaglia
- Department of Emergency and Organ Transplantation (DETO), Andrology and Kidney Transplantation Unit, Medical School, University of Bari, Bari, Italy
| | - L Gesualdo
- Department of Emergency and Organ Transplantation (DETO), Nephrology Division, Medical School, University of Bari, Bari, Italy
| | - L Resta
- Department of Emergency and Organ Transplantation (DETO), Pathology Division, Medical School, University of Bari, Bari, Italy
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28
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Chi J, Ma Y, Weng FL, Thiessen-Philbrook H, Parikh CR, Du H. Surface-enhanced Raman scattering analysis of urine from deceased donors as a prognostic tool for kidney transplant outcome. JOURNAL OF BIOPHOTONICS 2017; 10:1743-1755. [PMID: 28485029 PMCID: PMC5680137 DOI: 10.1002/jbio.201700019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/15/2017] [Accepted: 04/18/2017] [Indexed: 05/07/2023]
Abstract
We report the utility of surface-enhanced Raman scattering (SERS) analysis of urine from deceased donors for prognosis of kidney transplant outcomes. Iodide-modified silver nanoparticles were used as the enabler for sensitive measurements of urine proteins. Principal component analysis (PCA) and linear discriminant analysis (LDA) were employed for the statistical analysis of the SERS data. Thirty urine samples in three classes were analysed. The ATN class consists of donors whose kidneys had acute tubular necrosis (ATN), the most common type of acute kidney injury (AKI) with high risk of poor graft performance in recipients, yet yielded acceptable transplant outcome. The DGF class is comprised of donors whose kidney had delayed graft function (DGF) in recipients. The control class includes donors whose kidneys did not have donor ATN or recipient DGF. We show a sensitivity of more than 90 % in differentiating the ATN class from the DGF and control classes. Our methodology can thus help clinicians choose kidneys in the high-risk ATN category for transplant which would otherwise be discarded. Our research is impactful in that it could serve as a valuable guidance to expand the deceased donor pool to include those perceived as high-risk AKI type based on common urinary biomarkers. Picutre: Scheme of SERS analysis of urine samples from deceased donors for kidney transplant outcome indication.
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Affiliation(s)
- Jingmao Chi
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| | - Yiwei Ma
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| | - Francis L. Weng
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ 07039, USA
| | | | - Chirag R. Parikh
- Department of Medicine, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Henry Du
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, NJ 07030, USA
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29
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Abstract
BACKGROUND Kidneys with "high" Kidney Donor Profile Index (KDPI) are often biopsied and pumped, yet frequently discarded. METHODS In this multicenter study, we describe the characteristics and outcomes of kidneys with KDPI of 80 or greater that were procured from 338 deceased donors. We excluded donors with anatomical kidney abnormalities. RESULTS Donors were categorized by the number of kidneys discarded: (1) none (n = 154, 46%), (2) 1 discarded and 1 transplanted (n = 48, 14%), (3) both discarded (n = 136, 40%). Donors in group 3 were older, more often white, and had higher terminal creatinine and KDPI than group 1 (all P < 0.05). Biopsy was performed in 92% of all kidneys, and 47% were pumped. Discard was associated with biopsy findings and first hour renal resistance. Kidney injury biomarker levels (neutrophil gelatinase-associated lipocalin, IL-18, and kidney injury molecule-1 measured from donor urine at procurement and from perfusate soon after pump perfusion) were not different between groups. There was no significant difference in 1-year estimated glomerular filtration rate or graft failure between groups 1 and 2 (41.5 ± 18 vs 41.4 ± 22 mL/min per 1.73 m; P = 0.97 and 9% vs 10%; P = 0.76). CONCLUSIONS Kidneys with KDPI of 80 or greater comprise the most resource consuming fraction of our donor kidney pool and have the highest rates of discard. Our data suggest that some discarded kidneys with KDPI of 80 or greater are viable; however, current tools and urine and perfusate biomarkers to identify these viable kidneys are not satisfactory. We need better methods to assess viability of kidneys with high KDPI.
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30
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Moledina DG, Hall IE, Thiessen-Philbrook H, Reese PP, Weng FL, Schröppel B, Doshi MD, Wilson FP, Coca SG, Parikh CR. Performance of Serum Creatinine and Kidney Injury Biomarkers for Diagnosing Histologic Acute Tubular Injury. Am J Kidney Dis 2017; 70:807-816. [PMID: 28844586 DOI: 10.1053/j.ajkd.2017.06.031] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/23/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The diagnosis of acute kidney injury (AKI), which is currently defined as an increase in serum creatinine (Scr) concentration, provides little information on the condition's actual cause. To improve phenotyping of AKI, many urinary biomarkers of tubular injury are being investigated. Because AKI cases are not frequently biopsied, the diagnostic accuracy of concentrations of Scr and urinary biomarkers for histologic acute tubular injury is unknown. STUDY DESIGN Cross-sectional analysis from multicenter prospective cohort. SETTINGS & PARTICIPANTS Hospitalized deceased kidney donors on whom kidney biopsies were performed at the time of organ procurement for histologic evaluation. PREDICTORS (1) AKI diagnosed by change in Scr concentration during donor hospitalization and (2) concentrations of urinary biomarkers (neutrophil gelatinase-associated lipocalin [NGAL], liver-type fatty acid-binding protein [L-FABP], interleukin 18 [IL-18], and kidney injury molecule 1 [KIM-1]) measured at organ procurement. OUTCOME Histologic acute tubular injury. RESULTS Of 581 donors, 98 (17%) had mild acute tubular injury and 57 (10%) had severe acute tubular injury. Overall, Scr-based AKI had poor diagnostic performance for identifying histologic acute tubular injury and 49% of donors with severe acute tubular injury did not have AKI. The area under the receiver operating characteristic curve (AUROC) of change in Scr concentration for diagnosing severe acute tubular injury was 0.58 (95% CI, 0.49-0.67) and for any acute tubular injury was 0.52 (95% CI, 0.45-0.58). Compared with Scr concentration, NGAL concentration demonstrated higher AUROC for diagnosing both severe acute tubular injury (0.67; 95% CI, 0.60-0.74; P=0.03) and any acute tubular injury (0.60; 95% CI, 0.55-0.66; P=0.005). In donors who did not have Scr-based AKI, NGAL concentrations were higher with increasing severities of acute tubular injury (subclinical AKI). However, compared with Scr concentration, AUROCs for acute tubular injury diagnosis were not significantly higher for urinary L-FABP, IL-18, or KIM-1. LIMITATIONS The spectrum of AKI cause in deceased donors may be different from that of a general hospitalized population. CONCLUSIONS Concentrations of Scr and kidney injury biomarkers (L-FABP, IL-18, and KIM-1) lack accuracy for diagnosing acute tubular injury in hospitalized deceased donors. Although urinary NGAL concentration had slightly higher discrimination for acute tubular injury than did Scr concentration, its overall AUROC was still modest.
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Affiliation(s)
- Dennis G Moledina
- Program of Applied Translational Research, Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Isaac E Hall
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Heather Thiessen-Philbrook
- Program of Applied Translational Research, Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, Philadelphia, PA
| | | | | | | | - F Perry Wilson
- Program of Applied Translational Research, Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, New Haven, CT
| | - Steven G Coca
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chirag R Parikh
- Program of Applied Translational Research, Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, New Haven, CT.
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31
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Mohan S, Campenot E, Chiles MC, Santoriello D, Bland E, Crew RJ, Rosenstiel P, Dube G, Batal I, Radhakrishnan J, Sandoval PR, Guarrera J, Stokes MB, D'Agati V, Cohen DJ, Ratner LE, Markowitz G. Association between Reperfusion Renal Allograft Biopsy Findings and Transplant Outcomes. J Am Soc Nephrol 2017; 28:3109-3117. [PMID: 28684646 DOI: 10.1681/asn.2016121330] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 05/06/2017] [Indexed: 11/03/2022] Open
Abstract
Biopsy findings at the time of procurement of deceased donor kidneys remain the most common reason cited for kidney discard. To determine the value of renal allograft histology in predicting outcomes, we evaluated the significance of histologic findings, read by experienced renal pathologists, in 975 postreperfusion biopsy specimens collected from 2005 to 2009 after living donor (n=427) or deceased donor (n=548) renal transplant. We evaluated specimens for the degree of glomerulosclerosis, interstitial fibrosis and tubular atrophy, and vascular disease; specimens with a score of 0 or 1 (scale, 0-3) for each parameter were considered optimal. Overall, 66.3% of living donor kidneys and 50.7% of deceased donor kidneys received an optimal histology score (P<0.001). Irrespective of donor status, suboptimal kidneys came from older donors with a higher incidence of diabetes mellitus, hypertension, and obesity and a higher mean kidney donor risk index (all P<0.001). Death-censored outcomes after transplant differed significantly between optimal and suboptimal kidneys only in the deceased donor transplants (P=0.02). Regardless of histologic classification, outcomes with deceased donor kidneys were inferior to outcomes with living donor kidneys. However, 73.2% of deceased donor kidneys with suboptimal histology remained functional at 5 years. Our findings suggest that histologic findings on postreperfusion biopsy associate with outcomes after deceased donor but not living donor renal transplants, thus donor death and organ preservation-related factors may be of greater prognostic importance. Discarding donated kidneys on the basis of histologic factors may be inappropriate and merits further study.
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Affiliation(s)
- Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York; .,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and
| | | | - Mariana C Chiles
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | | | - Eric Bland
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | - R John Crew
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | | | - Geoffrey Dube
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | | | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | - P Rodrigo Sandoval
- Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - James Guarrera
- Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | - David J Cohen
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | - Lloyd E Ratner
- Surgery, Columbia University College of Physicians and Surgeons, New York, New York
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32
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Abstract
Zero-time kidney biopsies, obtained at time of transplantation, are performed in many transplant centers worldwide. Decisions on kidney discard, kidney allocation, and choice of peritransplant and posttransplant treatment are sometimes based on the histological information obtained from these biopsies. This comprehensive review evaluates the practical considerations of performing zero-time biopsies, the predictive performance of zero-time histology and composite histological scores, and the clinical utility of these biopsies. The predictive performance of individual histological lesions and of composite scores for posttransplant outcome is at best moderate. No single histological lesion or composite score is sufficiently robust to be included in algorithms for kidney discard. Dual kidney transplantation has been based on histological assessment of zero-time biopsies and improves outcome in individual patients, but the waitlist effects of this strategy remain obscure. Zero-time biopsies are valuable for clinical and translational research purposes, providing insight in risk factors for posttransplant events, and as baseline for comparison with posttransplant histology. The molecular phenotype of zero-time biopsies yields novel therapeutic targets for improvement of donor selection, peritransplant management and kidney preservation. It remains however highly unclear whether the molecular expression variation in zero-time biopsies could become a better predictor for posttransplant outcome than donor/recipient baseline demographic factors.
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33
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Matos AC, Câmara NO, REQUIãO-MOURA LR, Tonato EJ, Filiponi TC, SOUZA-DURãO M, Malheiros DENISEM, Fregonesi M, Borrelli M, Pacheco-Silva A. Presence of arteriolar hyalinosis in post-reperfusion biopsies represents an additional risk to ischaemic injury in renal transplant. Nephrology (Carlton) 2016; 21:923-929. [DOI: 10.1111/nep.12699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/16/2015] [Accepted: 12/07/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Ana Cristina Matos
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Niels O Câmara
- Nephrology Department; Federal University of São Paulo; São Paulo Brazil
- Immunology Department; São Paulo University; São Paulo Brazil
| | - Lúcio R REQUIãO-MOURA
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Eduardo J Tonato
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Thiago C Filiponi
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Marcelino SOUZA-DURãO
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - DENISE M Malheiros
- Pathology Department; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Maurício Fregonesi
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Milton Borrelli
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Alvaro Pacheco-Silva
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
- Nephrology Department; Federal University of São Paulo; São Paulo Brazil
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34
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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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35
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Puthumana J, Hall IE, Reese PP, Schröppel B, Weng FL, Thiessen-Philbrook H, Doshi MD, Rao V, Lee CG, Elias JA, Cantley LG, Parikh CR. YKL-40 Associates with Renal Recovery in Deceased Donor Kidney Transplantation. J Am Soc Nephrol 2016; 28:661-670. [PMID: 27451287 DOI: 10.1681/asn.2016010091] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 06/28/2016] [Indexed: 12/16/2022] Open
Abstract
Deceased donor kidneys with AKI are often discarded for fear of poor transplant outcomes. Donor biomarkers that predict post-transplant renal recovery could improve organ selection and reduce discard. We tested whether higher levels of donor urinary YKL-40, a repair phase protein, associate with improved recipient outcomes in a prospective cohort study involving deceased kidney donors from five organ procurement organizations. We measured urinary YKL-40 concentration in 1301 donors (111 had AKI, defined as doubling of serum creatinine) and ascertained outcomes in the corresponding 2435 recipients, 756 of whom experienced delayed graft function (DGF). Donors with AKI had higher urinary YKL-40 concentration (P<0.001) and acute tubular necrosis on procurement biopsies (P=0.05). In fully adjusted analyses, elevated donor urinary YKL-40 concentration associated with reduced risk of DGF in both recipients of AKI donor kidneys (adjusted relative risk, 0.51 [95% confidence interval (95% CI), 0.32 to 0.80] for highest versus lowest YKL-40 tertile) and recipients of non-AKI donor kidneys (adjusted relative risk, 0.79 [95% CI, 0.65 to 0.97]). Furthermore, in the event of DGF, elevated donor urinary YKL-40 concentration associated with higher 6-month eGFR (6.75 [95% CI, 1.49 to 12.02] ml/min per 1.73 m2) and lower risk of graft failure (adjusted hazard ratio, 0.50 [95% CI, 0.27 to 0.94]). These findings suggest that YKL-40 is produced in response to tubular injury and is independently associated with recovery from AKI and DGF. If ultimately validated as a prognostic biomarker, urinary YKL-40 should be considered in determining the suitability of donor kidneys for transplant.
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Affiliation(s)
- Jeremy Puthumana
- Program of Applied Translational Research, Department of Medicine and
| | - Isaac E Hall
- Program of Applied Translational Research, Department of Medicine and.,Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Francis L Weng
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, New Jersey
| | | | - Mona D Doshi
- Department of Medicine, Division of Nephrology, Wayne State University School of Medicine, Detroit, Michigan
| | - Veena Rao
- Program of Applied Translational Research, Department of Medicine and
| | - Chun Geun Lee
- Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island; and
| | - Jack A Elias
- Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island; and
| | - Lloyd G Cantley
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Chirag R Parikh
- Program of Applied Translational Research, Department of Medicine and .,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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36
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Oppong YD, Farber JL, Chervoneva I, Martinez Cantarin MP. Correlation of acute tubular injury in reperfusion biopsy with renal transplant outcomes. Clin Transplant 2016; 30:836-44. [PMID: 27146243 DOI: 10.1111/ctr.12757] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2016] [Indexed: 11/28/2022]
Abstract
Acute tubular injury (ATI) is common at reperfusion, but its relationship to graft outcomes is unclear. Prior studies lack standardization of morphological assessments and included elements of acute and chronic tubular injury. This study aimed to evaluate the impact of ATI on graft outcomes. Reperfusion biopsies from 2004 to 2009 were retrospectively reviewed. ATI was assessed by a new standardized scoring system. We also assessed chronic injury (CI) by the Banff criteria. Outcomes evaluated included glomerular filtration rate (GFR) at 1 and 5 years and delayed graft function (DGF), acute rejection (AR), graft and patient survival. ATI did not correlate with DGF, AR, graft or overall survival. Mild-moderate ATI was not predictive of GFR post-transplant. Moderate-severe CI was associated with lower GFR at 5 years with a mean difference of -7.14 mL/min/1.73 m(2) (P=.04) and overall survival (HR 2.44, P=.01). Other predictors of graft function included donor age, DGF, and AR. Histologic criteria of ATI at implantation in the absence of donor demographics or clinical information do not provide sufficient predictability in outcomes after transplantation. On the other hand, histologic assessment of CI correlates with GFR and overall survival.
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Affiliation(s)
- Yaa D Oppong
- Division of Hospital Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - John L Farber
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Inna Chervoneva
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
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37
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Epigenetics in Kidney Transplantation: Current Evidence, Predictions, and Future Research Directions. Transplantation 2016; 100:23-38. [PMID: 26356174 DOI: 10.1097/tp.0000000000000878] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epigenetic modifications are changes to the genome that occur without any alteration in DNA sequence. These changes include cytosine methylation of DNA at cytosine-phosphate diester-guanine dinucleotides, histone modifications, microRNA interactions, and chromatin remodeling complexes. Epigenetic modifications may exert their effect independently or complementary to genetic variants and have the potential to modify gene expression. These modifications are dynamic, potentially heritable, and can be induced by environmental stimuli or drugs. There is emerging evidence that epigenetics play an important role in health and disease. However, the impact of epigenetic modifications on the outcomes of kidney transplantation is currently poorly understood and deserves further exploration. Kidney transplantation is the best treatment option for end-stage renal disease, but allograft loss remains a significant challenge that leads to increased morbidity and return to dialysis. Epigenetic modifications may influence the activation, proliferation, and differentiation of the immune cells, and therefore may have a critical role in the host immune response to the allograft and its outcome. The epigenome of the donor may also impact kidney graft survival, especially those epigenetic modifications associated with early transplant stressors (e.g., cold ischemia time) and donor aging. In the present review, we discuss evidence supporting the role of epigenetic modifications in ischemia-reperfusion injury, host immune response to the graft, and graft response to injury as potential new tools for the diagnosis and prediction of graft function, and new therapeutic targets for improving outcomes of kidney transplantation.
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Pisarski P, Schleicher C, Hauser I, Becker JU. German recommendations for pretransplantation donor kidney biopsies. Langenbecks Arch Surg 2016; 401:133-40. [PMID: 26994917 DOI: 10.1007/s00423-016-1384-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/12/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE This manuscript reviews the data about the histopathologic and develops recommendations to standardise and improve the biopsy procedure, the biopsy handling, the histopathological evaluation, the communication of results and the collection of data from pretransplantation kidney biopsies of deceased donors in Germany. METHODS The recommendations are based on this literature review, on discussions at two workshops held by the German Society of Pathology and the German Organ Transplantation Foundation and on personal experiences of the authors. RESULTS These German recommendations advocate the use of punch biopsies, paraffin embedding and detailed descriptive reporting of histopathological findings. CONCLUSIONS These recommendations constitute only a starting point. Periodical revisions will help to simplify and optimise the recommendations with the ultimate goal to prospectively gather data for the elaboration of a computer-based algorithm that allows the exact prediction of transplantation outcome for a given match of donor and recipient.
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Affiliation(s)
- Przemyslav Pisarski
- Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany
| | | | - Ingeborg Hauser
- Medical Clinic III, Nephrology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jan U Becker
- Institute of Pathology, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
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Ramanathan R, Gupta G, Kim J, Quinn K, Behnke M, Kang L, Sharma A. Retroactive application of the new kidney allocation system to renal transplants performed in the ECD/SCD era. Clin Transplant 2015; 29:1148-55. [DOI: 10.1111/ctr.12642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Rajesh Ramanathan
- Hume-Lee Transplant Center; Virginia Commonwealth University; Richmond VA USA
| | - Gaurav Gupta
- Hume-Lee Transplant Center; Virginia Commonwealth University; Richmond VA USA
| | - Joohyun Kim
- Hume-Lee Transplant Center; Virginia Commonwealth University; Richmond VA USA
| | - Keri Quinn
- Hume-Lee Transplant Center; Virginia Commonwealth University; Richmond VA USA
| | - Martha Behnke
- Hume-Lee Transplant Center; Virginia Commonwealth University; Richmond VA USA
| | - Le Kang
- Department of Biostatistics; Virginia Commonwealth University; Richmond VA USA
| | - Amit Sharma
- Hume-Lee Transplant Center; Virginia Commonwealth University; Richmond VA USA
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40
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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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Hosgood SA, Barlow AD, Dormer J, Nicholson ML. The use of ex-vivo normothermic perfusion for the resuscitation and assessment of human kidneys discarded because of inadequate in situ perfusion. J Transl Med 2015; 13:329. [PMID: 26474973 PMCID: PMC4609141 DOI: 10.1186/s12967-015-0691-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/08/2015] [Indexed: 11/10/2022] Open
Abstract
Background Many kidneys are rejected for transplantation due to inadequate in situ perfusion during organ retrieval because of the risk of additional ischaemic injury and microvasculature thrombosis. This study describes the use of ex vivo normothermic perfusion (EVNP) for the resuscitation and assessment of human kidneys that were discarded after inadequate in situ perfusion. Methods Twenty-two human kidneys were retrieved but then deemed unsuitable for transplantation, primarily due to inadequate in situ perfusion. After a period of static cold storage, kidneys were perfused for 60 min with an oxygenated red cell based solution at 36 °C. Results Nineteen out of 22 kidneys (86 %) were from DCD donors. During EVNP, kidneys were assessed and scored based on their macroscopic appearance, measures of renal blood flow and urine production. Kidneys were scored from 1 indicating the least injury to 5, indicating the worst. Twelve kidneys had an EVNP score of 1–2, 7 scored 3–4 and 3 kidneys scored 5. The EVNP score 5 kidneys had a low level of tubular function compared to the score 1–4 kidneys. Their perfusion parameters did not improve during EVNP and they were considered non-transplantable. There was no association between the histological evaluation and EVNP parameters. Conclusion EVNP restores function ex vivo and enables an assessment of kidneys that have been declined for transplantation due to inadequate in situ perfusion.
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Affiliation(s)
- Sarah A Hosgood
- Transplant Group, Department of Infection, Immunity and Inflammation, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK. .,Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 OQQ, UK.
| | - A D Barlow
- Transplant Group, Department of Infection, Immunity and Inflammation, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK. .,Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 OQQ, UK.
| | - J Dormer
- Department of Medical and Social Care Education, University of Leicester, Leicester, LE1 9HN, UK.
| | - M L Nicholson
- Transplant Group, Department of Infection, Immunity and Inflammation, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK. .,Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 OQQ, UK.
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42
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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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43
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Wang CJ, Wetmore JB, Crary GS, Kasiske BL. The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review. Am J Transplant 2015; 15:1903-14. [PMID: 25772854 DOI: 10.1111/ajt.13213] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 01/25/2023]
Abstract
Despite a growing organ shortage in the United States, many deceased donor kidneys removed for transplantation are discarded. Kidney biopsy findings often play a role in these discards, although it is not clear whether biopsies reliably inform acceptance decisions. Therefore, we carried out a systematic review of the medical literature on the utility of both procurement and implantation biopsies for predicting posttransplant outcomes. Between January 1, 1994 and July 1, 2014, 47 studies were published in the English language literature that examined the association between pretransplant donor biopsy findings from 50 or more donors (with more than half being from deceased donors) and either posttransplant graft failure, delayed graft function, or graft function. In general, study quality was poor. All were retrospective or did not indicate if they were prospective. Results were heterogeneous, with authors as often as not concluding that biopsy results did not predict posttransplant outcomes. The percent glomerular sclerosis was most often examined, and failed to predict graft failure in 7 of 14 studies. Of 15 semiquantitative scoring systems proposed, none consistently predicted posttransplant outcomes across studies. Routine use of biopsies to help determine whether or not to transplant a kidney should be reexamined.
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Affiliation(s)
- C J Wang
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - J B Wetmore
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - G S Crary
- Department of Pathology, Hennepin County Medical Center, Minneapolis, MN
| | - B L Kasiske
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
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44
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Hall IE, Schröppel B, Doshi MD, Ficek J, Weng FL, Hasz RD, Thiessen-Philbrook H, Reese PP, Parikh CR. Associations of deceased donor kidney injury with kidney discard and function after transplantation. Am J Transplant 2015; 15:1623-31. [PMID: 25762442 PMCID: PMC4563988 DOI: 10.1111/ajt.13144] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 02/06/2023]
Abstract
Deceased donor kidneys with acute kidney injury (AKI) are often discarded due to fear of poor outcomes. We performed a multicenter study to determine associations of AKI (increasing admission-to-terminal serum creatinine by AKI Network stages) with kidney discard, delayed graft function (DGF) and 6-month estimated glomerular filtration rate (eGFR). In 1632 donors, kidney discard risk increased for AKI stages 1, 2 and 3 (compared to no AKI) with adjusted relative risks of 1.28 (1.08-1.52), 1.82 (1.45-2.30) and 2.74 (2.0-3.75), respectively. Adjusted relative risk for DGF also increased by donor AKI stage: 1.27 (1.09-1.49), 1.70 (1.37-2.12) and 2.25 (1.74-2.91), respectively. Six-month eGFR, however, was similar across AKI categories but was lower for recipients with DGF (48 [interquartile range: 31-61] vs. 58 [45-75] ml/min/1.73m(2) for no DGF, p < 0.001). There was significant favorable interaction between donor AKI and DGF such that 6-month eGFR was progressively better for DGF kidneys with increasing donor AKI (46 [29-60], 49 [32-64], 52 [36-59] and 58 [39-71] ml/min/1.73m(2) for no AKI, stage 1, 2 and 3, respectively; interaction p = 0.05). Donor AKI is associated with kidney discard and DGF, but given acceptable 6-month allograft function, clinicians should consider cautious expansion into this donor pool.
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Affiliation(s)
- Isaac E. Hall
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT,Section of Nephrology, Yale University School of Medicine, New Haven, CT
| | - Bernd Schröppel
- Section of Nephrology, Department of Internal Medicine 1, University Hospital, Ulm, Germany
| | | | - Joseph Ficek
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | | | | | | | | | - Chirag R. Parikh
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT,Section of Nephrology, Yale University School of Medicine, New Haven, CT,Veterans Affairs Connecticut Healthcare System, New Haven, CT
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45
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Affiliation(s)
- Sayeed Khan Malek
- Transplant Surgery, Brigham & Women's Hospital, Boston, Massachusetts
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