1
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Pines R, Iraheta YA, Dahmani KA, Cooper M, Waterman AD. Understanding Patients' and Living Donors' Kidney Paired Donation Educational Experiences and Recommendations for Improvement. Prog Transplant 2021; 32:19-26. [PMID: 34894855 DOI: 10.1177/15269248211064878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Educating potential kidney patients and living donors about the risks and benefits of kidney paired donation to ensure they make informed decisions is complex. This study aimed to increase understanding of patients' and donors' decision-making about donation, the educational content they received, and their recommendations for educational improvements. METHOD We conducted a mixed methods study, including semistructured interviews and quantitative surveys, with 43 participants (25 living donors; 18 kidney recipients). FINDINGS Participants reported that the benefits of paired donation motivated them to participate (ie, helping multiple people, receiving a transplant sooner, flexible timing of donation). Although deciding to participate in paired donation was a systematic, logical, and carefully considered process for some. For most, it was a quickly made, often emotion-based decision. Paired donation educational content on different topics varied, with recipients reporting receiving less information than donors about donor protections and processes to ameliorate the challenges faced, such as broken swaps and chains, and delays in matching. Those who faced challenges requested more information about donor protections and support during and after paired donation. Although many acknowledged their transplant coordinators' helpfulness, participants also recommended being more proactive in learning about kidney paired donation and speaking to former donors and recipients beforehand. DISCUSSION Standardized, health literate educational content addressing the gaps and variability in education received may help increase paired donation informed decision-making.
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Affiliation(s)
- Rachyl Pines
- Cottage Health Research Institute, 22854Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Yaquelin Arevalo Iraheta
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Katia A Dahmani
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Amy D Waterman
- Department of Surgery and J.C. Walter Jr. Center for Transplantation, 23534Houston Methodist Hospital, Houston, Texas, USA
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2
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Roth AE, Marino IR, Ekwenna O, Dunn TB, Paloyo SR, Tan M, Correa-Rotter R, Kuhr CS, Marsh CL, Ortiz J, Testa G, Sindhwani P, Segev DL, Rogers J, Punch JD, Forbes RC, Zimmerman MA, Ellis MJ, Rege A, Basagoitia L, Krawiec KD, Rees MA. Global kidney exchange should expand wisely. Transpl Int 2021; 33:985-988. [PMID: 32430941 DOI: 10.1111/tri.13656] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Ty B Dunn
- University of Pennsylvania, Philadelphia, PA, USA
| | - Siegfredo R Paloyo
- Philippine General Hospital, University of the Philippines, Manila, Philippines.,St. Luke's Medical Center, Manila, Philippines
| | | | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | - Jeffrey Rogers
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | | | | | | | | | - Aparna Rege
- Duke University Medical Center, Durham, NC, USA
| | - Laura Basagoitia
- General Regional Hospital No 1, Dr. Carlos Macgregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Michael A Rees
- University of Toledo, Toledo, OH, USA.,Alliance for Paired Kidney Donation, Perrysburg, OH, USA
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3
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Hays R, Gordon EJ, Ison MG, LaPointe Rudow D. Impact of the OPTN transmissible diseases policy and US PHS increased risk donor guidelines on living donor candidates. Am J Transplant 2019; 19:3233-3239. [PMID: 31338956 DOI: 10.1111/ajt.15541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/28/2019] [Accepted: 07/19/2019] [Indexed: 01/25/2023]
Abstract
Donor-derived human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) transmissions in transplantation have led to policies mandating assessment of donor behavioral history, and disclosure of donor increased risk (IR) status to recipients. Organ Procurement Transplantation Network (OPTN) policy safeguards were promulgated in the context of deceased donation, with its narrow time window for organ utilization and uncertainty about donor history. These policies have been applied to living donation without substantive data on risk of disease transmission in living donor transplantation. Unlike for deceased donors, the OPTN does not collect data on living donor IR status. Given the feasibility of thorough living donor evaluation via already-mandated lab tests and clinical assessments, living donor IR assessment and associated disclosures may have limited benefit in improving recipient informed consent. Applying the current IR policy to living donors may also introduce unintended consequences to donors and recipients, causing donors psychological harm, delays in donation to avoid IR status disclosure, and potential withdrawal from donation. We suggest strategies that reduce risk of harm to donor candidates while maintaining policy compliance, and review additional approaches for evaluating risk of disease transmission in living donor candidates. Data on the risk of disease transmission by living donors are needed to inform policy modification.
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Affiliation(s)
- Rebecca Hays
- Department of Coordinated Care, University of Wisconsin Madison, Madison, Wisconsin
| | - Elisa J Gordon
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael G Ison
- Department of Coordinated Care, University of Wisconsin Madison, Madison, Wisconsin
| | - Dianne LaPointe Rudow
- Recanati Miller Transplantation Institute New York, Mount Sinai Hospital, New York, New York
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4
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Pearson J, Turenne M, Leichtman A. The Executive Order on Kidney Care: An Opportunity to Improve Outcomes for Individuals With Kidney Disease. Kidney Int Rep 2019; 4:1519-1522. [PMID: 31889730 PMCID: PMC6933461 DOI: 10.1016/j.ekir.2019.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Jeffrey Pearson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan,
USA
| | - Marc Turenne
- Arbor Research Collaborative for Health, Ann Arbor, Michigan,
USA
| | - Alan Leichtman
- NEPHRESEARCH, LLC, Ann Arbor, Michigan, USA
- Department of Medicine, Division of Nephrology, University of Michigan,
Ann Arbor, Michigan, USA
- Correspondence: Alan Leichtman, NEPHRESEARCH, LLC, 5067
Polo Fields Drive, Ann Arbor, Michigan 48103, USA.
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5
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Ruck JM, Segev DL. Expanding deceased donor kidney transplantation: medical risk, infectious risk, hepatitis C virus, and HIV. Curr Opin Nephrol Hypertens 2018; 27:445-53. [PMID: 30169460 DOI: 10.1097/MNH.0000000000000456] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Due to the organ shortage, which prevents over 90 000 individuals in the United States from receiving life-saving transplants, the transplant community has begun to critically reevaluate whether organ sources that were previously considered too risky provide a survival benefit to waitlist candidates. RECENT FINDINGS Organs that many providers were previously unwilling to use for transplantation, including kidneys with a high Kidney Donor Profile Index or from increased risk donors who have risk factors for window period hepatitis C virus (HCV) and HIV infection, have been shown to provide a survival benefit to transplant waitlist candidates compared with remaining on dialysis. The development of direct-acting antivirals to cure HCV infection has enabled prospective trials on the transplantation of organs from HCV-infected donors into HCV-negative recipients, with promising preliminary results. Changes in legislation through the HIV Organ Policy Equity Act have legalized transplantations from HIV-positive deceased donors to HIV-positive recipients for the first time in the United States. SUMMARY Critical reexamination of deceased donor organs that were previously discarded has resulted in greater utilization of these organs, an increased number of deceased donor transplants, and the provision of life-saving treatment to more transplant waitlist candidates.
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6
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Bray M, Wang W, Rees MA, Song PXK, Leichtman AB, Ashby VB, Kalbfleisch JD. KPDGUI: An interactive application for optimization and management of a virtual kidney paired donation program. Comput Biol Med 2019; 108:345-353. [PMID: 31054501 DOI: 10.1016/j.compbiomed.2019.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES The aim in kidney paired donation (KPD) is typically to maximize the number of transplants achieved through the exchange of donors in a pool comprising incompatible donor-candidate pairs and non-directed (or altruistic) donors. With many possible options in a KPD pool at any given time, the most appropriate set of exchanges cannot be determined by simple inspection. In practice, computer algorithms are used to determine the optimal set of exchanges to pursue. Here, we present our software application, KPDGUI (Kidney Paired Donation Graphical User Interface), for management and optimization of KPD programs. METHODS While proprietary software platforms for managing KPD programs exist to provide solutions to the standard KPD problem, our application implements newly investigated optimization criteria that account for uncertainty regarding the viability of selected transplants and arrange for fallback options in cases where potential exchanges cannot proceed, with intuitive resources for visualizing alternative optimization solutions. RESULTS We illustrate the advantage of accounting for uncertainty and arranging for fallback options in KPD using our application through a case study involving real data from a paired donation program, comparing solutions produced under different optimization criteria and algorithmic priorities. CONCLUSIONS KPDGUI is a flexible and powerful tool for offering decision support to clinicians and researchers on possible KPD transplant options to pursue under different user-specified optimization schemes.
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Affiliation(s)
- Mathieu Bray
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA.
| | - Wen Wang
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA
| | - Michael A Rees
- University of Toledo Medical Center, Department of Urology, Toledo, OH, USA; Alliance for Paired Donation, Inc., Maumee, OH, USA
| | - Peter X-K Song
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA
| | | | - Valarie B Ashby
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA
| | - John D Kalbfleisch
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA
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7
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OʼDonoghue KJM, Reed RD, Knight SR, OʼCallaghan JM, Ayaz-Shah AA, Hassan S, Weissenbacher A, Morris PJ, Pengel LHM. Critical Appraisal of International Clinical Practice Guidelines in Kidney Transplantation Using the Appraisal of Guidelines for Research and Education II Tool: A Systematic Review. Transplantation 2018; 102:1419-39. [PMID: 30124634 DOI: 10.1097/TP.0000000000002255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although clinical practice guidelines (CPGs) are used for the development of local protocols in kidney transplantation (Ktx), the quality of their methodology is variable. This systematic review aimed to critically appraise international CPGs in all aspects of Ktx using the Appraisal of Guidelines for Research and Evaluation II tool. METHODS Clinical Practice Guidelines in Ktx and donation published between 2010 and 2017 were identified from MEDLINE, Embase, National Guideline Clearinghouse, National Health Service and National Institute for Health and Care Excellence Evidence Searches, and the websites of transplant societies. Using Appraisal of Guidelines for Research and Evaluation II, 3 appraisers assessed the quality of CPGs. Interrater reliability was measured using the intraclass correlation coefficient (ICC). RESULTS Searches identified 3168 records, and 115 CPGs were included. The highest scoring Appraisal of Guidelines for Research and Evaluation II domain was "scope and purpose" (80%; range, 30%-100%), followed by "clarity of presentation" (77%; range, 43%-98%), "editorial independence" (52%; range, 0%-94%), "rigor of development" (47%; range 6%-97%) and "stakeholder involvement" (41%; range, 11%-85%). The poorest scoring domain was "applicability" (31%; range, 3%-74%). Most CPGs were recommended for future use either with (63%) or without (18%) modifications. A small number (14%) were not recommended for future use or reviewers (5%) did not agree on recommending the CPG. The overall mean CPG quality score was 4 of 7 (range, 2-7). The mean ICC of 0.74 indicated substantial agreement between reviewers. CONCLUSIONS The quality of international CPGs in Ktx was variable, and most CPGs lacked key aspects of methodological robustness and transparency. Improvements in methodology, patient involvement, and strategies for implementation are required.
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8
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Mahmood A. Living kidney donor evaluation: A simplistic approach. J Med Sci 2019. [DOI: 10.4103/jmedsci.jmedsci_126_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Holscher CM, Jackson K, Thomas AG, Haugen CE, DiBrito SR, Covarrubias K, Gentry SE, Ronin M, Waterman AD, Massie AB, Wang JG, Segev DL. Temporal changes in the composition of a large multicenter kidney exchange clearinghouse: Do the hard-to-match accumulate? Am J Transplant 2018; 18:2791-2797. [PMID: 30063811 PMCID: PMC6287934 DOI: 10.1111/ajt.15046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/25/2023]
Abstract
One criticism of kidney paired donation (KPD) is that easy-to-match candidates leave the registry quickly, thus concentrating the pool with hard-to-match sensitized and blood type O candidates. We studied candidate/donor pairs who registered with the National Kidney Registry (NKR), the largest US KPD clearinghouse, from January 2012-June 2016. There were no changes in age, gender, BMI, race, ABO blood type, or panel-reactive antibody (PRA) of newly registering candidates over time, with consistent registration of hard-to-match candidates (59% type O and 38% PRA ≥97%). However, there was no accumulation of type O candidates over time, presumably due to increasing numbers of nondirected type O donors. Although there was an initial accumulation of candidates with PRA ≥97% (from 33% of the pool in 2012% to 43% in 2014, P = .03), the proportion decreased to 17% by June 2016 (P < .001). Some of this is explained by an increase in the proportion of candidates with PRA ≥97% who underwent a deceased donor kidney transplantation (DDKT) after the implementation of the Kidney Allocation System (KAS), from 8% of 2012 registrants to 17% of 2015 registrants (P = .02). In this large KPD clearinghouse, increasing participation of nondirected donors and the KAS have lessened the accumulation of hard-to-match candidates, but highly sensitized candidates remain hard-to-match.
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Affiliation(s)
| | - Kyle Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine E. Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sandra R. DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Karina Covarrubias
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sommer E. Gentry
- Department of Mathematics, United States Naval Academy, Annapolis, MD
| | | | - Amy D Waterman
- David Geffen School of Medicine at UCLA, Kidney Transplant Program, Los Angeles, CA, USA,Terasaki Research Institute, Los Angeles, CA, USA
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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10
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McDonald M, Veale J. The Onus for Altruism in Kidney Transplantation. Eur Urol Focus 2018; 4:206-207. [PMID: 30057344 DOI: 10.1016/j.euf.2018.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022]
Abstract
Ideally, all programs performing living donor kidney transplantation should educate patients on all contemporary exchange options. They should be strongly encouraged to participate in multicenter exchange, or at least refer those with a willing yet incompatible donor to a center that does, and to preferentially allocate altruistic donor kidneys towards chain initiation.
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Affiliation(s)
- Michelle McDonald
- Division of Renal Transplantation, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jefferey Veale
- Division of Renal Transplantation, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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11
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Holscher CM, Jackson K, Chow EKH, Thomas AG, Haugen CE, DiBrito SR, Purcell C, Ronin M, Waterman AD, Wang JG, Massie AB, Gentry SE, Segev DL. Kidney exchange match rates in a large multicenter clearinghouse. Am J Transplant 2018; 18:1510-1517. [PMID: 29437286 PMCID: PMC6082363 DOI: 10.1111/ajt.14689] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 01/25/2023]
Abstract
Kidney paired donation (KPD) can facilitate living donor transplantation for candidates with an incompatible donor, but requires waiting for a match while experiencing the morbidity of dialysis. The balance between waiting for KPD vs desensitization or deceased donor transplantation relies on the ability to estimate KPD wait times. We studied donor/candidate pairs in the National Kidney Registry (NKR), a large multicenter KPD clearinghouse, between October 2011 and September 2015 using a competing-risk framework. Among 1894 candidates, 52% were male, median age was 50 years, 66% were white, 59% had blood type O, 42% had panel reactive antibody (PRA)>80, and 50% obtained KPD through NKR. Median times to KPD ranged from 2 months for candidates with ABO-A and PRA 0, to over a year for candidates with ABO-O or PRA 98+. Candidates with PRA 80-97 and 98+ were 23% (95% confidence interval , 6%-37%) and 83% (78%-87%) less likely to be matched than PRA 0 candidates. ABO-O candidates were 67% (61%-73%) less likely to be matched than ABO-A candidates. Candidates with ABO-B or ABO-O donors were 31% (10%-56%) and 118% (82%-162%) more likely to match than those with ABO-A donors. Providers should counsel candidates about realistic, individualized expectations for KPD, especially in the context of their alternative treatment options.
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Affiliation(s)
- Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kyle Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric KH Chow
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine E Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sandra R DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Amy D Waterman
- David Geffen School of Medicine at UCLA, Kidney Transplant Program, Los Angeles, CA, USA,Terasaki Research Institute, Los Angeles, CA, USA
| | | | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Sommer E Gentry
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Mathematics, United States Naval Academy, Annapolis, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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12
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Mishra A, Lo A, Lee GS, Samstein B, Yoo PS, Levine MH, Goldberg DS, Shaked A, Olthoff KM, Abt PL. Liver paired exchange: Can the liver emulate the kidney? Liver Transpl 2018; 24:677-686. [PMID: 29427562 DOI: 10.1002/lt.25030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/14/2018] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
Kidney paired exchange (KPE) constitutes 12% of all living donor kidney transplantations (LDKTs) in the United States. The success of KPE programs has prompted many in the liver transplant community to consider the possibility of liver paired exchange (LPE). Though the idea seems promising, the application has been limited to a handful of centers in Asia. In this article, we consider the indications, logistical issues, and ethics for establishing a LPE program in the United States with reference to the principles and advances developed from experience with KPE. Liver Transplantation 24 677-686 2018 AASLD.
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Affiliation(s)
- Ashish Mishra
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Alexis Lo
- Temple University School of Medicine, Philadelphia, PA
| | - Grace S Lee
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.,Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA
| | - Benjamin Samstein
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Peter S Yoo
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Matthew H Levine
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David S Goldberg
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Abraham Shaked
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Kim M Olthoff
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Peter L Abt
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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13
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Abstract
The advanced donation program was proposed in 2014 to allow an individual to donate a kidney in order to provide a voucher for a kidney in the future for a particular loved one. In this article, we explore the logistical and ethical issues that such a program raises. We argue that such a program is ethical in principle but there are many logistical issues that need to be addressed to ensure that the actual program is fair to both those who do and do not participate in this program.
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Affiliation(s)
| | - James R Rodrigue
- Beth Israel Deaconess Medical Center, Boston, Massachussetts, USA
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14
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Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, Gallon L, Garvey CA, Guleria S, Li PKT, Segev DL, Taler SJ, Tanabe K, Wright L, Zeier MG, Cheung M, Garg AX. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017; 101:S1-S109. [PMID: 28742762 PMCID: PMC5540357 DOI: 10.1097/tp.0000000000001769] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.
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Affiliation(s)
| | | | | | | | - Josefina Alberú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Dorry L. Segev
- Johns Hopkins University, School of Medicine, Baltimore, MD
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15
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Gill JS, Tinckam K, Fortin MC, Rose C, Shick-Makaroff K, Young K, Lesage J, Cole EH, Toews M, Landsberg DN, Gill J. Reciprocity to Increase Participation of Compatible Living Donor and Recipient Pairs in Kidney Paired Donation. Am J Transplant 2017; 17:1723-1728. [PMID: 28321984 DOI: 10.1111/ajt.14275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/02/2017] [Accepted: 03/09/2017] [Indexed: 01/25/2023]
Abstract
Inclusion of compatible living donor and recipient pairs (CPs) in kidney paired donation (KPD) programs could increase living donor transplantation. We introduce the concept of a reciprocity-based strategy in which the recipient of a CP who participates in KPD receives priority for a repeat deceased donor transplant in the event their primary living donor KPD transplant fails, and then we review the practical and ethical considerations of this strategy. The strategy limits prioritization to CPs already committed to living donation, minimizing the risk of unduly influencing donor behavior. The provision of a tangible benefit independent of the CP's actual KPD match avoids many of the practical and ethical challenges with strategies that rely on finding the CP recipient a better-matched kidney that might provide the CP recipient a future benefit to increase KPD participation. Specifically, the strategy avoids the potential to misrepresent the degree of future benefit of a better-matched kidney to the CP recipient and minimizes delays in transplantation related to finding a better-matched kidney. Preliminary estimates suggest the strategy has significant potential to increase the number of living donor transplants. Further evaluation of the acceptance of this strategy by CPs and by waitlisted patients is warranted.
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Affiliation(s)
- J S Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada.,Division of Nephrology, Tuft-New England Medical Center, Boston, MA
| | - K Tinckam
- Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, Canada
| | - M C Fortin
- Department of Nephrology and Transplantation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Centre de Recherché du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - C Rose
- Division of Nephrology, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada
| | | | - K Young
- Canadian Blood Services, Ottawa, Canada
| | - J Lesage
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - E H Cole
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
| | - M Toews
- Health Law Institute, Faculty of Law, University of Alberta, Alberta, Canada
| | - D N Landsberg
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - J Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada
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16
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Bromberger B, Spragan D, Hashmi S, Morrison A, Thomasson A, Nazarian S, Sawinski D, Porrett P. Pregnancy-Induced Sensitization Promotes Sex Disparity in Living Donor Kidney Transplantation. J Am Soc Nephrol 2017; 28:3025-3033. [PMID: 28483798 DOI: 10.1681/asn.2016101059] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 04/04/2017] [Indexed: 01/29/2023] Open
Abstract
The presence of sex disparity in living donor kidney transplantation (LDKT) remains controversial. To determine if women fall behind men in LDKT evaluation, we performed an intention to treat study of 2587 candidates listed for kidney transplant at a single transplant center over 7 years. We found that women and men kidney transplant candidates engaged an equivalent type and number of prospective living donors. However, sex-specific differences in sensitization history and histocompatibility reduced the rate of LDKT for women by 30%. Pregnancy-induced incompatibility with spouse donors was limiting given that spouses were among the individuals most likely to complete donation. Notably, participation in a kidney paired exchange program eliminated sex-based differences in LDKT. Collectively, these data suggest that pregnancy is a formidable biologic barrier for women and contributes uniquely to sex disparity in LDKT. Targeted efforts to improve transplant center participation in paired kidney exchanges may increase sex equity in LDKT.
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Affiliation(s)
| | | | | | | | | | | | - Deirdre Sawinski
- Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
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17
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Rees MA, Dunn TB, Kuhr CS, Marsh CL, Rogers J, Rees SE, Cicero A, Reece LJ, Roth AE, Ekwenna O, Fumo DE, Krawiec KD, Kopke JE, Jain S, Tan M, Paloyo SR. Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation. Am J Transplant 2017; 17:782-790. [PMID: 27992110 DOI: 10.1111/ajt.14106] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/23/2016] [Accepted: 10/24/2016] [Indexed: 01/25/2023]
Abstract
Organ shortage is the major limitation to kidney transplantation in the developed world. Conversely, millions of patients in the developing world with end-stage renal disease die because they cannot afford renal replacement therapy-even when willing living kidney donors exist. This juxtaposition between countries with funds but no available kidneys and those with available kidneys but no funds prompts us to propose an exchange program using each nation's unique assets. Our proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient-donor pairs with immunological barriers and developing-world patient-donor pairs with financial barriers. By making developed-world health care available to impoverished patients in the developing world, we replace unethical transplant tourism with global kidney exchange-a modality equally benefitting rich and poor. We report the 1-year experience of an initial Filipino pair, whose recipient was transplanted in the United states with an American donor's kidney at no cost to him. The Filipino donor donated to an American in the United States through a kidney exchange chain. Follow-up care and medications in the Philippines were supported by funds from the United States. We show that the logistical obstacles in this approach, although considerable, are surmountable.
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Affiliation(s)
- M A Rees
- University of Toledo Medical Center, Toledo, OH.,Alliance for Paired Donation, Perrysburg, OH
| | - T B Dunn
- University of Minnesota, Minneapolis, MN
| | - C S Kuhr
- Virginia Mason Medical Center, Seattle, WA
| | - C L Marsh
- Scripps Green Hospital, La Jolla, CA
| | - J Rogers
- Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - S E Rees
- University of Toledo Medical Center, Toledo, OH.,Alliance for Paired Donation, Perrysburg, OH
| | - A Cicero
- ABC Medical Center, Mexico City, Mexico
| | - L J Reece
- Alliance for Paired Donation, Perrysburg, OH
| | - A E Roth
- Stanford University, Stanford, CA
| | - O Ekwenna
- University of Toledo Medical Center, Toledo, OH.,Alliance for Paired Donation, Perrysburg, OH
| | - D E Fumo
- University of Toledo Medical Center, Toledo, OH.,Alliance for Paired Donation, Perrysburg, OH
| | | | - J E Kopke
- Alliance for Paired Donation, Perrysburg, OH
| | - S Jain
- University of Toledo Medical Center, Toledo, OH
| | - M Tan
- Piedmont Hospital, Atlanta, GA
| | - S R Paloyo
- University of the Philippines-Philippine General Hospital, Manila, Philippines.,St. Luke's Medical Center-Global City, Manila, Philippines
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18
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Tong A, Sautenet B, Chapman JR, Harper C, MacDonald P, Shackel N, Crowe S, Hanson C, Hill S, Synnot A, Craig JC. Research priority setting in organ transplantation: a systematic review. Transpl Int 2017; 30:327-343. [PMID: 28120462 DOI: 10.1111/tri.12924] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 02/06/2023]
Abstract
Barriers to access and long-term complications remain a challenge in transplantation. Further advancements may be achieved through research priority setting with patient engagement to strengthen its relevance. We evaluated research priority setting in solid organ transplantation and described stakeholder priorities. Databases were searched to October 2016. We synthesized the findings descriptively. The 28 studies (n = 2071 participants) addressed kidney [9 (32%)], heart [7 (25%)], liver [3 (11%)], lung [1 (4%)], pancreas [1 (4%)], and nonspecified organ transplantation [7 (25%)] using consensus conferences, expert panel meetings, workshops, surveys, focus groups, interviews, and the Delphi technique. Nine (32%) reported patient involvement. The 336 research priorities addressed the following: organ donation [43 priorities (14 studies)]; waitlisting and allocation [43 (10 studies)]; histocompatibility and immunology [31 (8 studies)]; immunosuppression [21 (10 studies)]; graft-related complications [38 (13 studies)]; recipient (non-graft-related) complications [86 (14 studies)]; reproduction [14 (1 study)], psychosocial and lifestyle [49 (7 studies)]; and disparities in access and outcomes [10 (4 studies)]. The priorities identified were broad but only one-third of initiatives engaged patients/caregivers, and details of the process were lacking. Setting research priorities in an explicit manner with patient involvement can guide investment toward the shared priorities of patients and health professionals.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Benedicte Sautenet
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - Claudia Harper
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Peter MacDonald
- Heart Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia.,Transplantation Research Laboratory, Victor Chang, Cardiac Research Institute, Sydney, NSW, Australia
| | - Nicholas Shackel
- Department of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Camilla Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Vic., Australia
| | - Anneliese Synnot
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Vic., Australia.,School of Preventive Medicine and Public Health, Monash University, Melbourne, Vic., Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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19
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Massie AB, Leanza J, Fahmy LM, Chow EKH, Desai NM, Luo X, King EA, Bowring MG, Segev DL. A Risk Index for Living Donor Kidney Transplantation. Am J Transplant 2016; 16:2077-84. [PMID: 26752290 PMCID: PMC6114098 DOI: 10.1111/ajt.13709] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/20/2015] [Accepted: 12/13/2015] [Indexed: 01/25/2023]
Abstract
Choosing between multiple living kidney donors, or evaluating offers in kidney paired donation, can be challenging because no metric currently exists for living donor quality. Furthermore, some deceased donor (DD) kidneys can result in better outcomes than some living donor kidneys, yet there is no way to compare them on the same scale. To better inform clinical decision-making, we created a living kidney donor profile index (LKDPI) on the same scale as the DD KDPI, using Cox regression and adjusting for recipient characteristics. Donor age over 50 (hazard ratio [HR] per 10 years = 1.15 1.241.33 ), elevated BMI (HR per 10 units = 1.01 1.091.16 ), African-American race (HR = 1.15 1.251.37 ), cigarette use (HR = 1.09 1.161.23 ), as well as ABO incompatibility (HR = 1.03 1.271.58 ), HLA B (HR = 1.03 1.081.14 ) mismatches, and DR (HR = 1.04 1.091.15 ) mismatches were associated with greater risk of graft loss after living donor transplantation (all p < 0.05). Median (interquartile range) LKDPI score was 13 (1-27); 24.2% of donors had LKDPI < 0 (less risk than any DD kidney), and 4.4% of donors had LKDPI > 50 (more risk than the median DD kidney). The LKDPI is a useful tool for comparing living donor kidneys to each other and to deceased donor kidneys.
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Affiliation(s)
- A B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - J Leanza
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - L M Fahmy
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - E K H Chow
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - N M Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - X Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - E A King
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M G Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Scientific Registry for Transplant Recipients, Minneapolis, MN
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20
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Melcher ML, Roberts JP, Leichtman AB, Roth AE, Rees MA. Utilization of Deceased Donor Kidneys to Initiate Living Donor Chains. Am J Transplant 2016; 16:1367-70. [PMID: 26833680 PMCID: PMC4844828 DOI: 10.1111/ajt.13740] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/20/2016] [Accepted: 01/24/2016] [Indexed: 01/25/2023]
Abstract
We propose that some deceased donor (DD) kidneys be allocated to initiate nonsimultaneous extended altruistic donor chains of living donor (LD) kidney transplants to address, in part, the huge disparity between patients on the DD kidney waitlist and available donors. The use of DD kidneys for this purpose would benefit waitlisted candidates in that most patients enrolled in kidney paired donation (KPD) systems are also waitlisted for a DD kidney transplant, and receiving a kidney through the mechanism of KPD will decrease pressure on the DD pool. In addition, a LD kidney usually provides survival potential equal or superior to that of DD kidneys. If KPD chains that are initiated by a DD can end in a donation of an LD kidney to a candidate on the DD waitlist, the quality of the kidney allocated to a waitlisted patient is likely to be improved. We hypothesize that a pilot program would show a positive impact on patients of all ethnicities and blood types.
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Affiliation(s)
| | - John P. Roberts
- Surgery, University of California at San Francisco, San Francisco, CA
| | | | | | - Michael A. Rees
- Urology, University of Toledo Medical Center, Toledo, OH,Alliance for Paired Donation, Maumee, OH
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21
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Rodrigue JR, Feng S, Johansson AC, Glazier AK, Abt PL. Deceased Donor Intervention Research: A Survey of Transplant Surgeons, Organ Procurement Professionals, and Institutional Review Board Members. Am J Transplant 2016; 16:278-86. [PMID: 26484950 DOI: 10.1111/ajt.13482] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/09/2015] [Accepted: 08/10/2015] [Indexed: 01/25/2023]
Abstract
Innovative deceased donor intervention strategies have the potential to increase the number and quality of transplantable organs. Yet there is confusion over regulatory and legal requirements, as well as ethical considerations. We surveyed transplant surgeons (n = 294), organ procurement organization (OPO) professionals (n = 83), and institutional review board (IRB) members (n = 317) and found wide variations in their perceptions about research classification, risk assessment for donors and organ transplant recipients, regulatory oversight requirements, and informed consent in the context of deceased donor intervention research. For instance, when presented with different research scenarios, IRB members were more likely than transplant surgeons and OPO professionals to feel that study review and oversight were necessary by the IRBs at the investigator, donor, and transplant center hospitals. Survey findings underscore the need to clarify ethical, legal, and regulatory requirements and their application to deceased donor intervention research to accelerate the pace of scientific discovery and facilitate more transplants.
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Affiliation(s)
- J R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - S Feng
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - A C Johansson
- Harvard Medical School, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - P L Abt
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
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22
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Casey MJ, Wen X, Rehman S, Santos AH, Andreoni KA. Rethinking the advantage of zero-HLA mismatches in unrelated living donor kidney transplantation: implications on kidney paired donation. Transpl Int 2015; 28:401-9. [PMID: 25440520 DOI: 10.1111/tri.12495] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/09/2014] [Accepted: 11/24/2014] [Indexed: 11/26/2022]
Abstract
The OPTN/UNOS Kidney Paired Donation (KPD) Pilot Program allocates priority to zero-HLA mismatches. However, in unrelated living donor kidney transplants (LDKT)-the same donor source in KPD-no study has shown whether zero-HLA mismatches provide any advantage over >0 HLA mismatches. We hypothesize that zero-HLA mismatches among unrelated LDKT do not benefit graft survival. This retrospective SRTR database study analyzed LDKT recipients from 1987 to 2012. Among unrelated LDKT, subjects with zero-HLA mismatches were compared to a 1:1-5 matched (by donor age ±1 year and year of transplantation) control cohort with >0 HLA mismatches. The primary endpoint was death-censored graft survival. Among 32,654 unrelated LDKT recipients, 83 had zero-HLA mismatches and were matched to 407 controls with >0 HLA mismatches. Kaplan-Meier analyses for death-censored graft and patient survival showed no difference between study and control cohorts. In multivariate marginal Cox models, zero-HLA mismatches saw no benefit with death-censored graft survival (HR = 1.46, 95% CI 0.78-2.73) or patient survival (HR = 1.43, 95% CI 0.68-3.01). Our data suggest that in unrelated LDKT, zero-HLA mismatches may not offer any survival advantage. Therefore, particular study of zero-HLA mismatching is needed to validate its place in the OPTN/UNOS KPD Pilot Program allocation algorithm.
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23
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Fumo DE, Kapoor V, Reece LJ, Stepkowski SM, Kopke JE, Rees SE, Smith C, Roth AE, Leichtman AB, Rees MA. Historical Matching Strategies in Kidney Paired Donation: The 7-Year Evolution of a Web-Based Virtual Matching System. Am J Transplant 2015; 15:2646-54. [PMID: 26015291 PMCID: PMC5551043 DOI: 10.1111/ajt.13337] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/28/2015] [Indexed: 01/25/2023]
Abstract
Failure to convert computer-identified possible kidney paired donation (KPD) exchanges into transplants has prohibited KPD from reaching its full potential. This study analyzes the progress of exchanges in moving from "offers" to completed transplants. Offers were divided into individual segments called 1-way transplants in order to calculate success rates. From 2007 to 2014, the Alliance for Paired Donation performed 243 transplants, 31 in collaboration with other KPD registries and 194 independently. Sixty-one of 194 independent transplants (31.4%) occurred via cycles, while the remaining 133 (68.6%) resulted from nonsimultaneous extended altruistic donor (NEAD) chains. Thirteen of 35 (37.1%) NEAD chains with at least three NEAD segments accounted for 68% of chain transplants (8.6 tx/chain). The "offer" and 1-way success rates were 21.9 and 15.5%, respectively. Three reasons for failure were found that could be prospectively prevented by changes in protocol or software: positive laboratory crossmatch (28%), transplant center declined donor (17%) and pair transplanted outside APD (14%). Performing a root cause analysis on failures in moving from offer to transplant has allowed the APD to improve protocols and software. These changes have improved the success rate and the number of transplants performed per year.
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Affiliation(s)
- D. E. Fumo
- The Alliance for Paired Donation, Maumee, OH,Department of Urology, University of Toledo Medical Center, Toledo, OH
| | - V. Kapoor
- Department of Urology, University of Toledo Medical Center, Toledo, OH
| | - L. J. Reece
- The Alliance for Paired Donation, Maumee, OH
| | - S. M. Stepkowski
- The Alliance for Paired Donation, Maumee, OH,Department of Urology, University of Toledo Medical Center, Toledo, OH
| | - J. E. Kopke
- The Alliance for Paired Donation, Maumee, OH
| | - S. E. Rees
- The Alliance for Paired Donation, Maumee, OH,Department of Urology, University of Toledo Medical Center, Toledo, OH
| | - C. Smith
- The Alliance for Paired Donation, Maumee, OH,Department of Urology, University of Toledo Medical Center, Toledo, OH
| | - A. E. Roth
- Department of Economics, Stanford University, Stanford, CA
| | - A. B. Leichtman
- Department of Medicine, The University of Michigan, Ann Arbor, MI
| | - M. A. Rees
- The Alliance for Paired Donation, Maumee, OH,Department of Urology, University of Toledo Medical Center, Toledo, OH,Corresponding author: Michael A. Rees,
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24
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Moore DR, Serur D, Rudow DL, Rodrigue JR, Hays R, Cooper M. Living Donor Kidney Transplantation: Improving Efficiencies in Live Kidney Donor Evaluation--Recommendations from a Consensus Conference. Clin J Am Soc Nephrol 2015; 10:1678-86. [PMID: 26268509 DOI: 10.2215/cjn.01040115] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The education, evaluation, and support of living donors before, during, and after donation have historically been considered the roles and responsibilities of transplant programs. Although intended to protect donors, ensure true informed consent, and prevent coercion, this structure often leaves referring nephrologists unclear about the donor process and uncertain regarding the ultimate outcome of potential donors for their patients. The aim of this article is to help the referring nephrologist understand the donor referral and evaluation process, help the referring nephrologist understand the responsibilities of the transplant program, and offer suggestions about how the referring nephrologist can help to improve efficiencies in the process of donor education and evaluation. A partnership between referring nephrologists and transplant programs is an important step in advancing living kidney donation. The referring nephrologists are the frontline providers and are in a unique position to offer education about living donation and improve efficiencies in the process. Understanding the donor referral and evaluation process, the responsibilities of the transplant program, and the potential role referring nephrologists can play in the process is critical to establishing such a partnership.
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Affiliation(s)
- Deonna R Moore
- Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee;
| | - David Serur
- New York Presbyterian Hospital, Cornell University, New York, New York
| | - Dianne LaPointe Rudow
- Recanati/Miller Transplant Institute, Mount Sinai Medical Center, New York, New York
| | - James R Rodrigue
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rebecca Hays
- Transplant Center, University of Wisconsin Hospital, Madison, Wisconsin; and
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Georgetown University, Washington, DC
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25
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Liu W, Treat E, Veale JL, Milner J, Melcher ML. Identifying Opportunities to Increase the Throughput of Kidney Paired Donation. Transplantation 2015; 99:1410-5. [DOI: 10.1097/tp.0000000000000527] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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26
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Rodrigue JR, Kazley AS, Mandelbrot DA, Hays R, LaPointe Rudow D, Baliga P. Living Donor Kidney Transplantation: Overcoming Disparities in Live Kidney Donation in the US--Recommendations from a Consensus Conference. Clin J Am Soc Nephrol 2015; 10:1687-95. [PMID: 25883072 DOI: 10.2215/cjn.00700115] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Despite its superior outcomes relative to chronic dialysis and deceased donor kidney transplantation, live donor kidney transplantation (LDKT) is less likely to occur in minorities, older adults, and poor patients than in those who are white, younger, and have higher household income. In addition, there is considerable geographic variability in LDKT rates. Concomitantly, in recent years, the rate of living kidney donation (LKD) has stopped increasing and is declining, after decades of consistent growth. Particularly noteworthy is the decline in LKD among black, younger, male, and lower-income adults. The Live Donor Community of Practice within the American Society of Transplantation, with financial support from 10 other organizations, held a Consensus Conference on Best Practices in Live Kidney Donation in June 2014. The purpose of this meeting was to identify LKD best practices and knowledge gaps that might influence LDKT, with a focus on patient and donor education, evaluation efficiencies, disparities, and systemic barriers to LKD. In this article, we discuss trends in LDKT/LKD and emerging novel strategies for attenuating disparities, and we offer specific recommendations for future clinical practice, education, research, and policy from the Consensus Conference Workgroup focused on disparities.
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Affiliation(s)
- James R Rodrigue
- Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Abby Swanson Kazley
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Didier A Mandelbrot
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin; and
| | - Rebecca Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin; and
| | - Dianne LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York
| | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina;
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27
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Rudow DL, Hays R, Baliga P, Cohen DJ, Cooper M, Danovitch GM, Dew MA, Gordon EJ, Mandelbrot DA, McGuire S, Milton J, Moore DR, Morgieivich M, Schold JD, Segev DL, Serur D, Steiner RW, Tan JC, Waterman AD, Zavala EY, Rodrigue JR. Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J Transplant 2015; 15:914-22. [PMID: 25648884 PMCID: PMC4516059 DOI: 10.1111/ajt.13173] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/07/2014] [Accepted: 12/21/2014] [Indexed: 01/25/2023]
Abstract
Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation.
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Affiliation(s)
| | - Rebecca Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - David J. Cohen
- Department of Medicine, Columbia University Medical Center, New York, NY
| | | | - Gabriel M. Danovitch
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Elisa J. Gordon
- Comprehensive Transplant Center and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Suzanne McGuire
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Jennifer Milton
- Transplant Center, University of Texas at San Antonio, San Antonio, TX
| | - Deonna R. Moore
- Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - Marie Morgieivich
- The Living Donor Institute, Barnabas Health Transplant Division, Livingston, NJ
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Serur
- Department of Medicine, Cornell University, New York, NY
| | - Robert W. Steiner
- Department of Medicine, University of California at San Diego, San Diego, CA
| | - Jane C. Tan
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Amy D. Waterman
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Edward Y. Zavala
- Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - James R. Rodrigue
- Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Rodrigue JR, Leishman R, Vishnevsky T, Evenson A, Mandelbrot DA. Concerns of ABO incompatible and crossmatch-positive potential donors and recipients about participating in kidney exchanges. Clin Transplant 2015; 29:233-41. [PMID: 25581082 DOI: 10.1111/ctr.12509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2015] [Indexed: 01/29/2023]
Abstract
Kidney paired exchanges (KPEs) have increased, yet are still underutilized. This study aimed to develop tools for assessing KPE concerns, identify predictors of KPE concerns, and describe common KPE concerns among potential living donors (LDs) and intended recipients. Incompatible former potential LDs (n = 135) and intended recipients (n = 83) retrospectively completed questionnaires to assess KPE concerns. Healthcare system distrust also was assessed. A minority (n = 48 or 36.5% of potential LDs; n = 25 or 30.1% of intended recipients) had pursued KPE participation. Of those who pursued KPE participation, 11 (22.9%) and 6 (24.0%) completed KPE donation or transplantation, respectively. The questionnaires for potential LDs and recipients showed good internal consistency and preliminary convergent validity. LDs and patients less willing to pursue KPE reported more KPE concerns. Common KPE concerns for both potential LDs and recipients were related to perceived Distrust/Inequity and Inconvenience/Cost. Multivariate predictors of more KPE concerns were as follows: male gender (t = 4.5, p < 0.001) and more healthcare system distrust (t = 2.5, p = 0.01) for potential LDs; black race (t = 2.1, p = 0.04) and more healthcare system distrust (t = 2.3, p = 0.03) for intended recipients. These findings underscore the importance of addressing concerns potential LDs and patients have about KPE if the true potential of KPE is to be realized.
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Affiliation(s)
- James R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Serur D, Charlton M, Lawton M, Sinacore J, Gordon-Elliot J. Donors in chains: psychosocial outcomes of kidney donors in paired exchange. Prog Transplant 2014; 24:371-4. [PMID: 25488561 DOI: 10.7182/pit2014222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Kidney paired donation chains are initiated by nondirected donors and propagated by donors within the chain of transplants, or chain donors. OBJECTIVE To compare psychosocial and functional outcomes, and to test coercion, of chain donors in paired exchange versus traditional directed donors who have an established relationship with the recipient. METHODS Thirty chain donors from a transplant center who were part of the National Kidney Registry paired exchange program were compared with 34 traditional donors who donated around the same time. Participants completed online surveys: the postdonation section of the Living Donor Expectancies Questionnaire was used to assess psychosocial and functional outcomes 1 to 6 years after donation. A survey to assess coercion was used as well. RESULTS Chain donors and traditional donors were similar in terms of sex, race, age, and time after donation. The 2 groups had similar altruistic motives in donating their kidney, and both types of donors mentioned psychological benefits. No differences were found on questions regarding psychosocial outcomes save for the "quid pro quo scale" (P= .01), which suggested that the traditional donors felt more that the recipients are indebted to them. The 2 groups did not differ significantly in the coercion measure. Pressure to donate and stress of donation were not greater in chain donors than traditional donors (P= .60). CONCLUSION Kidney donors in kidney paired donation chains do as well as traditional donors psychosocially without any increased tendency toward experiencing coercion.
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Affiliation(s)
- David Serur
- New York Presbyterian-Weill Cornell, New York, New York
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Li H, Stegall MD, Dean PG, Casey ET, Reddy KS, Khamash HA, Heilman RL, Mai ML, Taner CB, Kosberg CL, Bakken LL, Wozniak EJ, Giles KL, Veal LA, Gandhi MJ, Cosio FG, Prieto M. Assessing the efficacy of kidney paired donation--performance of an integrated three-site program. Transplantation 2014; 98:300-5. [PMID: 24699400 DOI: 10.1097/TP.0000000000000054] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Kidney paired donation (KPD) has emerged as a viable option for renal transplant candidates with incompatible living donors. The aim of this study was to assess the "performance" of a three-site KPD program that allowed screening of multiple donors per recipient. METHODS We reviewed retrospectively the activity of our KPD program involving three centers under the same institutional umbrella. The primary goal was to achieve a transplant that was both ABO compatible and had a negative or low-positive flow cytometric crossmatch (+XM). RESULTS During the 40-month study period, 114 kidney transplant candidates were enrolled-57% resulting from a +XM and 39% resulting from ABO incompatible (ABOi) donors. Important outcomes were as follows: (1) 81 (71%) candidates received a transplant and 33 (29%) were still waiting; (2) 368 donors were evaluated, including 10 nondirected donors; (3) 82% (37/45) of ABOi candidates underwent transplantation; (4) 56% (36/65) of +XM candidates underwent transplantation (however, all but four of these had a cPRA less than 95%); (5) at the end of the study period, 97% (28/29) of +XM candidates still waiting had a cPRA greater than 95%. CONCLUSIONS These data suggest evaluating large numbers of donors increases the chances of KPD. Patients with a cPRA greater than 95% are unlikely to receive a negative or low-positive +XM, suggesting the need for desensitization protocols in KPD.
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Baxter-Lowe LA, Cecka M, Kamoun M, Sinacore J, Melcher ML. Center-defined unacceptable HLA antigens facilitate transplants for sensitized patients in a multi-center kidney exchange program. Am J Transplant 2014; 14:1592-8. [PMID: 24934640 DOI: 10.1111/ajt.12734] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 02/21/2014] [Accepted: 02/26/2014] [Indexed: 01/25/2023]
Abstract
Multi-center kidney paired donation (KPD) is an exciting new transplant option that has not yet approached its full potential. One barrier to progress is accurate virtual crossmatching for KPD waitlists with many highly sensitized patients. Virtual crossmatch results from a large multi-center consortium, the National Kidney Registry (NKR), were analyzed to determine the effectiveness of flexible center-specific criteria for virtual crossmatching. Approximately two-thirds of the patients on the NKR waitlist are highly sensitized (>80% CPRA). These patients have antibodies against HLA-A (63%), HLA-B (66%), HLA-C (41%), HLA-DRB1 (60%), HLA-DRB3/4/5 (18-22%), HLA-DQB1 (54%) and HLA-DPB1 (26%). With donors typed for these loci before activation, 91% of virtual crossmatches accurately predicted an acceptable cell-based donor crossmatch. Failed virtual crossmatches were attributed to equivocal virtual crossmatches (46%), changes in HLA antibodies (21%), antibodies against HLA-DQA (6%), transcription errors (6%), suspected non-HLA antibodies (5%), allele-specific antibodies (1%) and unknown causes (15%). Some failed crossmatches could be prevented by modifiable factors such as more frequent assessment of HLA antibodies, DQA1 typing of donors and auditing data entry. Importantly, when transplant centers have flexibility to define crossmatch criteria, it is currently feasible to use virtual crossmatching for highly sensitized patients to reliably predict acceptable cell-based crossmatches.
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Affiliation(s)
- L A Baxter-Lowe
- HLA Laboratory, Children's Hospital Los Angeles, Los Angeles, CA
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Kute VB, Gumber MR, Shah PR, Patel HV, Vanikar AV, Modi PR, Shah VR, Trivedi HL. Successful three-way kidney paired donation transplantation: The first Indian report. Indian J Nephrol 2014; 24:45-7. [PMID: 24574632 PMCID: PMC3927192 DOI: 10.4103/0971-4065.125094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Providing transplantation opportunities for patients with incompatible live donors through kidney paired donation (KPD) is an important strategy for easing the crisis in organ availability. KPD is can overcome the barriers when the only living potential donors are deemed unsuitable owing to an incompatibility of blood type, of human leukocyte antigen cross-match, or both. In KPD, the incompatibility problems with two donor recipient pairs can be solved by exchanging donors. In the absence of well-organized deceased donor program, or transplantation with desensitization protocol and ABO incompatible transplantation, living donor KPD promises hope to the growing number of patients suffering from end-stage renal disease in India. We report our first successful three-way KPD transplantation from India. In an era of organ shortage, this approach is relevant to encourage wider participation from KPD donors and transplant centers to prevent commercial transplantation.
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Affiliation(s)
- V B Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - M R Gumber
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - P R Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - H V Patel
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - A V Vanikar
- Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - P R Modi
- Department of Urology and Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - V R Shah
- Department of Anesthesia and Critical Care, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - H L Trivedi
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India
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Abstract
There has been dramatic growth in the last decade in the literature on psychosocial and financial impacts of living organ donation. With this growth has come recognition that these impacts must be considered when educating prospective donors about the donation process, and when planning donor follow-up care after donation. Our review highlights recent studies that provide new information on the nature of psychosocial and financial outcomes in living donors, with special attention to studies examining unrelated donors (i.e., those with no biologic or longstanding emotional connection to the transplant patient), given that these individuals represent a growing segment of the living donor population. Limitations and gaps in available evidence are noted. We also discuss recent recommendations for post-donation monitoring of donors' psychosocial and financial outcomes, and we consider advances in evidence regarding interventions and prevention strategies to minimize any adverse psychosocial and financial impacts of living donation.
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Affiliation(s)
- Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213 USA, 412-624-3373
| | - Larissa Myaskovsky
- Departments of Medicine, Psychiatry and Clinical and Translational Science, University of Pittsburgh School of Medicine and Medical Center and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, 412-692-4856
| | - Jennifer L Steel
- Departments of Surgery, Psychiatry and Psychology, University of Pittsburgh School of Medicine and Medical Center, 3459 Fifth Avenue; MUH 7S, Pittsburgh PA 15213, 412-692-2041
| | - Andrea F DiMartini
- Departments of Psychiatry and Surgery, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213 USA, 412-383-3166
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Kute VB, Vanikar AV, Shah PR, Gumber MR, Patel HV, Engineer DP, Modi PR, Shah VR, Trivedi HL. Does donor-recipient age difference matter in outcome of kidney transplantation? Implications for kidney paired donation. Ren Fail 2013; 36:378-83. [PMID: 24295219 DOI: 10.3109/0886022x.2013.862769] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Kidney paired donation (KPD) is a rapidly growing modality for facilitating living donor kidney transplantation (LDKTx) for patients who are incompatible with their healthy, willing and living donor. The impact of donor-recipient age difference on long and short-term graft and patient survivals in LDKTx is still uncertain. METHODS A total of 1502 LDKTx recipients who received regular follow-up in our center from 1999 to 2012 were studied. Donor-recipient age difference was divided into subgroups (donor-recipient 0-10, 11-20, 0-20, 21-30, 31-40, and 21-40 years). Outcome measures included death censored graft, patient survival and acute rejection rate. RESULTS The 1-, 5-, 10-year patient survival of the donor-recipient age difference ≤20 years group showed no difference compared with the age difference >20 years group (94.5%, 83.2%, 71.9% and 95.2%, 86%, 77.8%, p = 0.053). The 1-, 5-, 10-year graft survival of the donor-recipient age difference ≤20 years group showed no difference compared with the age difference >20 years group (94.6%, 81.6%, 72.1% and 94%, 80%, 72.2%, p = 0.989). The rejection were also similar (17.5% vs. 16.5%, p > 0.05). There was no statistically significant difference in graft survival and acute rejection rate in all subgroups. CONCLUSIONS Older donors (usually within families) are not associated with worse outcome is reassuring. KPD should not be prohibited due to high donor-recipient age difference, when size of donor pool is small as in single center KPD program.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS) , Ahmedabad , India
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Abstract
Unspecified kidney donation is an emerging resource to bridge the gap between supply and demand of kidneys for transplantation. However, uncertainty remains among both the transplantation community and lay public with regard to the intention, motivation, and legitimacy of such donors. Even within programs that use unspecified kidney donors, there is a lack of consensus regarding how to optimize the potential of the gifted kidney (and indirectly potentiate the altruistic benefit for the donor). Despite emerging guidance on how to work up unspecified donors, centers have adopted individualized unspecified donor pathways with regards to assessment, evaluation, and use. There are a variety of models for unspecified kidney donation, ranging from donation directly to deceased-donor waiting lists to benefit one recipient or chain transplantations occurring simultaneously (domino-paired donation) or nonsimultaneously (extended altruistic donor chains) to benefit many. After a brief exploration on the basis of altruism, this review will discuss the assessment, evaluation, and reported outcomes associated with unspecified kidney donation. It will also critique current utilization models and highlight some unresolved controversies. The aim is to highlight the principles, practice, and potential of unspecified kidney donation to bridge the current disparate international practice.
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Kute VB, Vanikar AV, Shah PR, Gumber MR, Patel HV, Engineer DP, Modi PR, Rizvi SJ, Shah VR, Modi MP, Kanodia KV, Trivedi HL. Ten kidney paired donation transplantation on World Kidney Day 2013: raising awareness and time to take action to increase donor pool. Ren Fail 2013; 35:1269-72. [PMID: 23937166 DOI: 10.3109/0886022x.2013.823997] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Kidney paired donation (KPD) is feasible for any center that performs living related donor renal transplantation (LRDRTx). Lack of awareness, counseling and participation are important hurdles in KPD patients with incompatible donors. MATERIALS AND METHODS This is an institutional review board approved study of 10 ESRD patients who consented to participate in the KPD transplantation at our center. All the surgeries were carried out on the same day at the same center on the occasion of World Kidney Day (WKD) (14 March 2013). All recipients had anatomic, functional and immunological similar donors. RESULTS KPD were performed to avoid blood group incompatibility (n = 8) or to avoid a positive crossmatch (n = 2). None of the patients experienced delayed graft function and surgical complications. At 3 month follow-up, median serum creatinine was 1 (range 0.6 to 1.25) mg/dL and two patients developed allograft biopsy-proven acute rejection and responded to antirejection therapy. Due to impact of our awareness activity, 20 more KPD patients are medically fit for transplantation and waiting for permission from the authorization committee before transplantation. CONCLUSION This is a report of 10 simultaneous KPD transplantations in a single day in a single centre on WKD raising awareness of KPD. KPD is viable, legal and rapidly growing modality for facilitating LRDRTx for patients who are incompatible with their healthy, willing LRD.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Clinical Transplantation
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Ojo AO, Merion RM, Howard DH, Warren PH. Response to "dynamic challenges inhibiting optimal adoption of kidney paired donation: findings of a consensus conference" by Melcher et al. Am J Transplant 2013; 13:2228. [PMID: 23834021 DOI: 10.1111/ajt.12345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 04/30/2013] [Indexed: 01/25/2023]
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