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Perry J, McLeod MC, Reed RD, Baker GA, Stanford LA, Allen J, Jones B, Robinson T, MacLennan PA, Kumar V, Locke JE. Patient-Level and Center-Level Factors Associated with Required Predonation Weight Loss among Obese Living Kidney Donors. Kidney360 2024; 5:437-444. [PMID: 38319632 PMCID: PMC11000741 DOI: 10.34067/kid.0000000000000381] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
Key Points Among obese living kidney donors, year of donation, preoperative body mass index, hypertension, and center percent of living kidney donor transplants were associated with required predonation weight loss. There were no significant differences in the likelihood of predonation weight loss requirement by race, sex, or age or by markers of preoperative metabolic dysfunction. Background The proportion of overweight/mildly obese living kidney donors (OLKDs) has increased in the past few decades, with significant center variation in the body mass index (BMI) of LKDs. The purpose of this study was to examine factors associated with required predonation weight loss among OLKDs (BMI, ≥30 kg/m2). Methods This retrospective cohort study surveyed 1097 OLKDs (1979–2020) (mean BMI, 33 kg/m2) about their donation experience. Bivariate analyses compared donor demographic and center characteristics by whether the donor reported predonation weight loss requirement. Generalized estimating equations with logit link were used to estimate marginal effects of patient-level and center-level factors. Multiple imputation using chained equations was implemented to account for missing values. Results Of 1097 OLKDs surveyed, 340 (31.0%) reported predonation weight loss requirement. Donors with a predonation weight loss requirement had slightly higher predonation BMIs and donated in more recent years at centers performing a lower percentage of living donor nephrectomies and with a lower median BMI. In multivariable logistic regression analysis, we observed transplant year (odds ratio [OR], 1.04 per year donation; 95% confidence interval [CI], 1.01 to 1.07; P = 0.005), preoperative BMI (OR, 1.16; 95% CI, 1.05 to 1.28; P < 0.01), preoperative hypertension (OR, 1.61; 95% CI, 1.08 to 2.40; P = 0.02), and center percentage of living donor kidney transplants (OR, 0.99; 95% CI, 0.98 to 1.00; P = 0.02) as significantly associated with a predonation weight loss requirement. The study found no differences in the likelihood of predonation weight loss requirement by race, sex, age, preoperative creatinine, preoperative metabolic dysfunction, or center-level median BMI of living donors. Conclusions These results suggest that both center-level and patient-level factors influence whether OLKDs are required to lose weight before donation. Future study is needed to determine whether predonation weight loss is associated with improved long-term postdonation outcomes.
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Affiliation(s)
- Jackson Perry
- University of Alabama Comprehensive Transplant Institute, Birmingham, Alabama
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Dhalla A, Ravani P, Quinn RR, Garg AX, Clarke A, Al-Wahsh H, Lentine KL, Klarenbach S, Hemmelgarn BR, Wang C, Lam NN. Risk Factors for Developing Low Estimated Glomerular Filtration Rate and Albuminuria in Living Kidney Donors. Kidney Med 2024; 6:100767. [PMID: 38313807 PMCID: PMC10837092 DOI: 10.1016/j.xkme.2023.100767] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Rationale & Objective Chronic kidney disease is associated with significant morbidity and mortality in the general population, but little is known about the incidence and risk factors associated with developing low estimated glomerular filtration rate (eGFR) and moderate-severe albuminuria in living kidney donors following nephrectomy. Study Design Retrospective, population-based cohort study. Setting & Participants Kidney donors in Alberta, Canada. Exposure Donor nephrectomy between May 2001 and December 2017. Outcome Two eGFR measurements <45 mL/min/1.73 m2 or 2 measurements of moderate or severe albuminuria from 1-year postdonation onwards that were at least 90 days apart. Analytical Approach Associations between potential risk factors and the primary outcome were assessed using Cox proportional hazard regression analyses. Results Over a median follow-up period of 8.6 years (IQR, 4.7-12.6 years), 47 of 590 donors (8.0%) developed sustained low eGFR or moderate-severe albuminuria with an incidence rate of 9.2 per 1,000 person-years (95% confidence interval, 6.6-11.8). The median time for development of this outcome beyond the first year after nephrectomy was 2.9 years (IQR, 1.4-8.0 years). Within the first 4 years of follow-up, a 5 mL/min/1.73 m2 lower predonation eGFR increased the hazard of developing postdonation low eGFR or moderate-severe albuminuria by 26% (adjusted HR, 1.26; 95% CI, 1.10-1.44). Furthermore, donors were at higher risk of developing low eGFR or albuminuria if they had evidence of predonation hypertension (adjusted HR, 2.52; 95% CI, 1.28-4.96) or postdonation diabetes (adjusted HR, 4.72; 95% CI, 1.54-14.50). Limitations We lacked data on certain donor characteristics that may affect long-term kidney function, such as race, smoking history, and transplant-related characteristics. Conclusions A proportion of kidney donors at an incidence rate of 9.2 per 1,000 person-years will develop low eGFR or albuminuria after donation. Donors with lower predonation eGFR, predonation hypertension, and postdonation diabetes are at increased risk of developing this outcome.
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Affiliation(s)
- Anisha Dhalla
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Pietro Ravani
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Robert R Quinn
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Amit X Garg
- Department of Medicine, Division of Nephrology, Western University, London, ON, Canada
| | - Alix Clarke
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Huda Al-Wahsh
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University Hospital, St. Louis, MO
| | - Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, AB, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, AB, Canada
| | - Carol Wang
- Department of Medicine, Division of Nephrology, Western University, London, ON, Canada
| | - Ngan N Lam
- Cumming School of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
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Bamgboye EL. Kidney Transplantation in Sub-Saharan Africa: History and Current Status. Kidney360 2023; 4:1772-1775. [PMID: 37962555 PMCID: PMC10758520 DOI: 10.34067/kid.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023]
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Tesema B, Bogale EK, Wasihun Y, Anagaw TF. Intention to Donate Kidney and Associated Factors Among Students in Bahir Dar University: Application of Theory of Planned Behavior. Int J Gen Med 2023; 16:5363-5376. [PMID: 38021069 PMCID: PMC10674569 DOI: 10.2147/ijgm.s441636] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background Kidney donation is the donation of a kidney from a living or dead person to another living person who requires transplantation. The scarcity of kidneys is a great public health concern worldwide, owing to an increase in end-stage renal failure. There is no sufficient evidence regarding the intention to donate kidneys in Ethiopia. Objective To assess the intention to donate kidneys and its associated factors among Bahir Dar University students in Ethiopia in 2023 by the application of theory of planned behavior. Method and Materials This institution-based cross-sectional study was conducted from March 7 to April 5, 2023. A multistage sampling technique was used to select 630 participants. Self-administered structured questionnaires were used to collect data. Data were entered into Epi-data version 4.6, and exported to the Statistical Package for the Social Sciences (SPSS) version 25 for analysis. Bivariate and multivariate linear regression analyses were performed. Findings with a p-value <0.05 at the 95% confidence interval were considered statistically significant and interpreted by the unstandardized beta (ß) coefficient. Results The mean score of intention to donate the kidney was 12.9 ± 4.1 standard deviation. Direct attitude (B = 0.341, 95% CI = 0.265, 0.416), direct subjective norm (B = 0.088, 95% CI = 0.010, 0.167), direct perceived behavioral control (B = 0.353, 95% CI 0.251, 0.455), knowledge (B = 0.417, 95% CI 0.251, 0.583), and previous experience of blood donation (B = 0.915, 95% CI 0.321, 1.510) were factors associated with intention to kidney donation. Conclusion The mean score of intention to donate kidneys was 12.9 ± 4.1 SD. Direct attitude, direct subjective norm, direct perceived behavioral control, experience with blood donation, and knowledge of participants were significant factors for the intention to donate kidneys. Therefore, social and behavioral change communication strategies should address these factors in order to increase kidney donation.
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Affiliation(s)
- Belete Tesema
- Department Public Health, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Eyob Ketema Bogale
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yosef Wasihun
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadele Fentabil Anagaw
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Kilambi V, Barah M, Formica RN, Friedewald JJ, Mehrotra S. Evaluation of Opening Offers Early for Deceased Donor Kidneys at Risk of Nonutilization. Clin J Am Soc Nephrol 2023; 19:01277230-990000000-00287. [PMID: 37943856 PMCID: PMC10861110 DOI: 10.2215/cjn.0000000000000346] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Reducing nonutilization of kidneys recovered from deceased donors is a current policy concern for kidney allocation in the United States. The likelihood of nonutilization is greater with a higher kidney donor risk index (KDRI) offer. We examine how opening offers for organs with KDRI >1.75 to the broader waitlist at varying points of time affects usage rates. METHODS We simulate kidney allocation using data for January 2018 to June 2019 from Organ Procurement and Transplantation Network. For the simulation experiment, allocation policy is modified so that KDRI >1.75 organs are offered to all local candidates (same donation service area) after a set amount of cold time simultaneously. Open offers to candidates nationally are similarly examined. RESULTS Simulation results ( n =50 replications) estimate that opening offers locally for KDRI >1.75 after 10 hours yields a nonutilization rate of 38% (range: 35%-42%), less than the prevailing rate of 55% of KDRI >1.75 kidneys. Opening offers after 5 hours yields 30% (range: 26%-34%), reducing the prevailing nonutilization rate by 45%. Opening offers nationally after 10 and 5 hours yields nonutilization rates of 11% (range: 8%-15%) and 6% (range: 4%-9%) for KDRI >1.75 kidneys, respectively. CONCLUSIONS Simulation findings indicate that opening offers and adjusting their timing can significantly reduce nonutilization of high-KDRI kidneys.
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Affiliation(s)
- Vikram Kilambi
- Department of Engineering and Applied Sciences, RAND Corporation, Arlington, Virginia
- RAND Health Care, Access and Delivery Program, RAND Corporation, Arlington, Virginia
| | - Masoud Barah
- Department of Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois
| | - Richard N. Formica
- Department of Nephrology, Yale School of Medicine, New Haven, Connecticut
| | - John J. Friedewald
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Nephrology, Department of Medicine, Northwestern University, Chicago, Illinois
- Center for Engineering and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjay Mehrotra
- Department of Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Nephrology, Department of Medicine, Northwestern University, Chicago, Illinois
- Center for Engineering and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Schold JD, Huml AM, Husain SA, Poggio ED, Buchalter RB, Lopez R, Kaplan B, Mohan S. Deceased donor kidneys from higher distressed communities are significantly less likely to be utilized for transplantation. Am J Transplant 2023; 23:1723-1732. [PMID: 37001643 DOI: 10.1016/j.ajt.2023.03.019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
The proportion of kidneys procured for transplantation but not utilized exceeds 20% in the United States. Factors associated with nonutilization are complex, and further understanding of novel causes are critically important. We used the national Scientific Registry of Transplant Recipients data (2010-2022) to evaluate associations of Distressed Community Index (DCI) of deceased donor residence and likelihood of kidney nonutilization (n = 209 413). Deceased donors from higher distressed communities were younger, had an increased history of hypertension and diabetes, were CDC high-risk, and had higher terminal creatinine and donation after brain death. Mechanisms and circumstances of death varied significantly by DCI. The proportion of kidney nonutilization was 19.9%, which increased by DCI quintile (Q1 = 18.1% to Q5 = 21.6%). The adjusted odds ratio of nonutilization from the highest quintile DCI communities was 1.22 (95% CI = 1.16-1.28; reference = lowest DCI), which persisted stratified by donor race. Donors from highly distressed communities were highly variable by the donor service area (range: 1%-51%; median = 21%). There was no increased risk for delayed graft function or death-censored graft loss by donor DCI but modest increased adjusted hazard for overall graft loss (high DCI = 1.05; 95% CI = 1.01-1.10; reference = lowest DCI). Results indicate that donor residential distress is associated with significantly higher rates of donor kidney nonutilization with notable regional variation and minimal impact on recipient outcomes.
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Affiliation(s)
- Jesse D Schold
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
| | - Anne M Huml
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - S Ali Husain
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Emilio D Poggio
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - R Blake Buchalter
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rocio Lopez
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bruce Kaplan
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sumit Mohan
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Epidemiology, Columbia University, New York, New York, USA
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7
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Rasmussen LV, Agrawal AH, Gordon EJ. Transplant Nephrologists' Preferences for Clinical Decision Support for APOL1 Genetic Testing of Living Kidney Donors: A Focus Group Study. Kidney360 2023; 4:1610-1614. [PMID: 38032814 PMCID: PMC10695637 DOI: 10.34067/kid.0000000000000265] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
Key Points Opportunities exist for clinical decision support (CDS) to help transplant nephrologists counsel living donors receiving apolipoprotein L1 (APOL1 ) genetic test results. CDS for APOL1 genetic test results should provide access to patient education materials and reminders at follow-up appointments. Optimal APOL1 CDS would notify providers when results are available, provide information on follow-up appointments, and provide access to patient education materials. Podcast This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2023_12_01_KID0000000000000265.mp3
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Affiliation(s)
- Luke V. Rasmussen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Akansha H. Agrawal
- Departments of Medicine and Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elisa J. Gordon
- Department of Surgery, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
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Lim WH, Au E, Teixeira-Pinto A, Ooi E, Opdam H, Chapman J, Johnson DW, Kanellis J, Davies CE, Wong G. Donors With a Prior History of Cancer: Factors of Non-Utilization of Kidneys for Transplantation. Transpl Int 2023; 36:11883. [PMID: 38020745 PMCID: PMC10643206 DOI: 10.3389/ti.2023.11883] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
Cancer transmission from deceased donors is an exceedingly rare but potentially fatal complication in transplant recipients. We aimed to quantify the likelihood of non-utilization of kidneys for transplantation from donors with a prior cancer history. We included all intended and actual deceased donors in Australia and New Zealand between 1989 and 2017. Association between prior cancer history and non-utilization of donor kidneys was examined using adjusted logistic regression. Of 9,485 deceased donors, 345 (4%) had a prior cancer history. Of 345 donors with a prior cancer history, 197 (57%) were utilized for transplantation. Donor characteristics of age, sex and comorbidities were similar between utilized and non-utilized donors with prior cancer. The time from cancer to organ donation was similar between utilized and non-utilized donors, irrespective of cancer subtypes. Donors with a prior cancer history were less likely to be utilized [adjusted OR (95% CI) 2.29 (1.68-3.13)] than donors without prior cancer. Of all actual donors, the adjusted OR for non-utilization among those with prior cancer was 2.36 (1.58-3.53). Non-melanoma skin cancer was the most frequent prior cancer type for utilized and non-utilized potential donors. Donors with prior cancers were less likely to be utilized for transplantation, with no discernible differences in cancer characteristics between utilized and non-utilized donors.
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Affiliation(s)
- Wai H. Lim
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Eric Au
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Esther Ooi
- Medical School, University of Western Australia, Perth, WA, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Helen Opdam
- DonateLife, Organ and Tissue Authority, Canberra, NSW, Australia
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Jeremy Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - David W. Johnson
- Princess Alexandra Hospital, Metro South Integrated Nephrology and Transplant Services, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health, Melbourne, VIC, Australia
- Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia
| | - Christopher E. Davies
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Germaine Wong
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children’s Hospital at Westmead, Sydney, NSW, Australia
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Reddy NA, Reyad AI, Allam SR. The Art and Science of Kidney Transplant Offer Evaluation. Cureus 2023; 15:e43223. [PMID: 37692692 PMCID: PMC10491006 DOI: 10.7759/cureus.43223] [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] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Currently, there are more than 100,000 patients on the transplant waitlist in the United States. There exists a significant gap between the supply and demand for kidney transplants. Despite this, about a quarter of kidneys recovered from deceased donors are not being utilized. There is a significant variation in kidney acceptance criteria by transplant centers. The current kidney allocation system allows transplant centers to place kidneys into appropriate recipients who may not be at the top of the list to increase organ utilization. A recent study questioned this practice of "list diving." In this editorial, we seek to support "list diving" through a discussion of the various factors a transplant center could take into consideration while evaluating organ offers.
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Affiliation(s)
- Nikhil A Reddy
- North Texas Division, HCA Healthcare Research Institute, Fort Worth, USA
| | - Ashraf I Reyad
- Transplant Surgery, Medical City Fort Worth Transplant Institute, Fort Worth, USA
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10
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Jalbert J, Weller JN, Boivin PL, Lavigne S, Taobane M, Pieper M, Lodi A, Cardinal H. Predicting Time to and Average Quality of Future Offers for Kidney Transplant Candidates Declining a Current Deceased Donor Kidney Offer: A Retrospective Cohort Study. Can J Kidney Health Dis 2023; 10:20543581231177844. [PMID: 37313365 PMCID: PMC10259098 DOI: 10.1177/20543581231177844] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/10/2023] [Indexed: 06/15/2023] Open
Abstract
Background At the time a kidney offer is made by an organ donation organization (ODO), transplant physicians must inform candidates on the pros and cons of accepting or declining the offer. Although physicians have a general idea of expected wait time to kidney transplantation by blood group in their ODO, there are no tools that provide quantitative estimates based on the allocation score used and donor/candidate characteristics. This limits the shared decision-making process at the time of kidney offer as (1) the consequences of declining an offer in terms of wait-time prolongation cannot be provided and (2) the quality of the current offer cannot be compared with that of offers that could be made to the specific candidate in the future. This is especially relevant to older transplant candidates as many ODOs use some form of utility matching in their allocation score. Objective We aimed to develop a novel method to provide personalized estimates of wait time to next offer and quality of future offers for kidney transplant candidates if they refused a current deceased donor offer from an ODO. Design A retrospective cohort study. Setting Administrative data from Transplant Quebec. Patients All patients who were actively registered on the kidney transplant wait list at any point between March 29, 2012 and December 13, 2017. Measurements The time to next offer was defined as the number of days between the time of the current offer and the next offer if the current one were declined. The quality of the offers was measured with the 10-variable Kidney Donor Risk Index (KDRI) equation. Methods Candidate-specific kidney offer arrival was modeled with a marked Poisson process. To derive the lambda parameter for the marked Poisson process for each candidate, the arrival of donors was examined in the 2 years prior to the time of the current offer. The Transplant Quebec allocation score was calculated for each ABO-compatible offer with the characteristics that the candidate presented at the time of the current offer. Offers where the candidate's score was lower than the scores of actual recipients of the second kidneys transplanted were filtered out from the candidate-specific kidney offer arrival. The KDRIs of offers that remained were averaged to provide an estimate of the quality of future offers, to be compared with that of the current offer. Results During the study period, there were 848 unique donors and 1696 transplant candidates actively registered. The models provide the following information: average time to next offer, time to which there is a 95% probability of receiving a next offer, average KDRI of future offers. The C-index of the model was 0.72. When compared with providing average group estimates of wait time and KDRI of future offers, the model reduced the root-mean-square error in the predicted time to next offer from 137 to 84 days and that of predicted KDRI of future offers from 0.64 to 0.55. The precision of the model's predictions was higher when observed times to next offer were 5 months or less. Limitations The models assume that patients declining an offer remain wait-listed until the next one. The model only updates wait time every year after the time of an offer and not in a continuous fashion. Conclusion By providing personalized quantitative estimates of time to and quality of future offers, our new approach can inform the shared decision-making process between transplant candidates and physicians when a kidney offer from a deceased donor is made by an ODO.
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Affiliation(s)
- Jonathan Jalbert
- Department of Mathematics and Industrial Engineering, Polytechnique Montréal, QC, Canada
| | - Jean-Noel Weller
- Canada Excellence Research Chair, Polytechnique Montréal, QC, Canada
| | - Pierre-Luc Boivin
- Department of Mathematics and Industrial Engineering, Polytechnique Montréal, QC, Canada
| | | | - Mehdi Taobane
- Canada Excellence Research Chair, Polytechnique Montréal, QC, Canada
| | - Mike Pieper
- Canada Excellence Research Chair, Polytechnique Montréal, QC, Canada
| | - Andrea Lodi
- Canada Excellence Research Chair, Polytechnique Montréal, QC, Canada
- Jacobs Technion-Cornell Institute, Cornell Tech, Technion—Israel Institute of Technology, New York City, New York, USA
| | - Héloise Cardinal
- Research Centre, Centre Hospitalier de l’Université de Montréal, QC, Canada
- Université de Montréal, QC, Canada
- The Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
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11
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Maple H, Gogalniceanu P, Gare R, Burnapp L, Draper H, Chilcot J, Norton S, Mamode N. Donating a Kidney to a Stranger: Are Healthcare Professionals Facilitating the Journey? Results From the BOUnD Study. Transpl Int 2023; 36:11257. [PMID: 37324220 PMCID: PMC10261699 DOI: 10.3389/ti.2023.11257] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023]
Abstract
Unspecified kidney donors (UKDs) are approached cautiously by some transplant professionals. The aim of this study was to interrogate the views of UK transplant professionals towards UKDs and identify potential barriers. A purposely designed questionnaire was validated, piloted and distributed amongst transplant professionals at each of the 23 UK transplant centres. Data captured included personal experiences, attitudes towards organ donation, and specific concerns about UKD. 153 responses were obtained, with representation from all UK centres and professional groups. The majority reported a positive experience with UKDs (81.7%; p < 0.001) and were comfortable with UKDs undergoing major surgery (85.7%; p < 0.001). 43.8% reported UKDs to be more time consuming and 52% felt that a mental health assessment should take place before any medical tests. 77% indicated the need for a lower age limit. The suggested age range was broad (16-50 years). Adjusted mean acceptance scores did not differ by profession (p = 0.68) but higher volume centres were more accepting (46.2 vs. 52.9; p < 0.001). This is the first quantitative study of acceptance by transplant professionals to a large national UKD programme. Support is broad, however potential barriers to donation have been identified, including lack of training. Unified national guidance is needed to address these.
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Affiliation(s)
- Hannah Maple
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Petrut Gogalniceanu
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Rebecca Gare
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lisa Burnapp
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- UK and NHS Blood and Transplant, Bristol, United Kingdom
| | - Heather Draper
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Nizam Mamode
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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12
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Kline TL. Beyond the Protons-Sodium MR Imaging Provides New Kidney Insights. Kidney360 2023; 4:569-571. [PMID: 37229724 PMCID: PMC10371284 DOI: 10.34067/kid.0000000000000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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13
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Enninga EAL, Garovic VD. Novel mechanism of increased preeclampsia risk after kidney donation. Kidney Int 2023; 103:653-655. [PMID: 36948763 PMCID: PMC10758218 DOI: 10.1016/j.kint.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/18/2023] [Indexed: 03/24/2023]
Affiliation(s)
| | - Vesna D Garovic
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
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14
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Wuttiputhanun T, Udomkarnjananun S, Hanprathet N, Jiamjarasrangsi W, Townamchai N, Avihingsanon Y, Katavetin P. Metabolic effects of kidney donation: A Bayesian analysis of matched cohorts. Nephrology (Carlton) 2023; 28:148-153. [PMID: 36515383 DOI: 10.1111/nep.14136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/10/2022] [Revised: 12/04/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
The kidney is a notable site of glycolysis, gluconeogenesis, and fatty acid oxidation. Loss of a kidney after kidney donation might, therefore, affect the glucose and lipid metabolism of the donors. This matched cohort study investigated the effect of nephrectomy on glucose and lipid metabolisms using Bayesian hypothesis testing. There were 77 pairs of matched donor-control pairs in the present study. Clinical and laboratory data of the participants, at baseline and 1-year, were extracted from electronic medical records. Comparisons between donor and control groups were performed using the Bayesian independent samples t-test or Bayesian Mann-Whitney test. The Bayes Factor for alternative hypothesis over null hypothesis (BF10 ) was used to compare the two competing hypotheses. The BF10 of 3 or more was considered evidence for the alternative hypothesis. Comparing changes from baseline to 1-year between donors and controls, the BF10 of triglycerides, high-density lipoprotein cholesterol (HDL-C), triglyceride-glucose (TyG) index of insulin resistance, and estimated glomerular filtration rate (eGFR) were 7.95, 3.96, 30.13, and 1.32 x 1041 , respectively signifying that the change of these variables in the donors differed from those in the controls (alternative hypothesis). Triglyceride, HDL-C, and TyG index of the donors increased more than those of the controls while eGFR of the donor decreased more than that of the controls. Our data suggest that triglycerides and insulin resistance increase after donor nephrectomy. Kidney donors should be informed about these metabolic changes and should adhere to lifestyle recommendations that may mitigate insulin resistance.
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Affiliation(s)
- Thunyatorn Wuttiputhanun
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Suwasin Udomkarnjananun
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Renal Immunology and Renal Transplant Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nitt Hanprathet
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Wiroj Jiamjarasrangsi
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nattavudh Townamchai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Renal Immunology and Renal Transplant Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yingyos Avihingsanon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pisut Katavetin
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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15
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Boadu P, McLaughlin L, Al-Haboubi M, Bostock J, Noyes J, O'Neill S, Mays N. A machine-learning approach to estimating public intentions to become a living kidney donor in England: Evidence from repeated cross-sectional survey data. Front Public Health 2023; 10:1052338. [PMID: 36684997 PMCID: PMC9846224 DOI: 10.3389/fpubh.2022.1052338] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/30/2022] [Indexed: 01/05/2023] Open
Abstract
Background Living kidney organ donors offer a cost-effective alternative to deceased organ donation. They enable patients with life-threatening conditions to receive grafts that would otherwise not be available, thereby creating space for other patients waiting for organs and contributing to reducing overall waiting times for organs. There is an emerging consensus that an increase in living donation could contribute even more than deceased donation to reducing inequalities in organ donation between different population sub-groups in England. Increasing living donation is thus a priority for National Health Service Blood and Transplant (NHSBT) in the United Kingdom. Methods Using the random forest model, a machine learning (ML) approach, this study analyzed eight waves of repeated cross-sectional survey data collected from 2017 to 2021 (n = 14,278) as part of the organ donation attitudinal tracker survey commissioned by NHSBT in England to identify and help predict key factors that inform public intentions to become living donors. Results Overall, around 58.8% of the population would consider donating their kidney to a family member (50.5%), a friend (28%) or an unknown person (13.2%). The ML algorithm identified important factors that influence intentions to become a living kidney donor. They include, in reducing order of importance, support for organ donation, awareness of organ donation publicity campaigns, gender, age, occupation, religion, number of children in the household, and ethnic origin. Support for organ donation, awareness of public campaigns, and being younger were all positively associated with predicted propensity for living donation. The variable importance scores show that ethnic origin and religion were less important than the other variables in predicting living donor intention. Conclusion Factors influencing intentions to become a living donor are complex and highly individual in nature. Machine learning methods that allow for complex interactions between characteristics can be helpful in explaining these decisions. This work has identified important factors and subgroups that have higher propensity for living donation. Interventions should target both potential live donors and recipients. Research is needed to explore the extent to which these preferences are malleable to better understand what works and in which contexts to increase live organ donation.
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Affiliation(s)
- Paul Boadu
- Policy Innovation and Evaluation Research Unit, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Leah McLaughlin
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Mustafa Al-Haboubi
- Policy Innovation and Evaluation Research Unit, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jennifer Bostock
- Policy Innovation and Evaluation Research Unit, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Stephen O'Neill
- Policy Innovation and Evaluation Research Unit, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nicholas Mays
- Policy Innovation and Evaluation Research Unit, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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16
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Isaacson D, Schold JD, Gmeiner MW, Copley HC, Kosmoliaptsis V, Tambur AR. HLA-DQ Mismatches Lead to More Unacceptable Antigens, Greater Sensitization, and Increased Disparities in Repeat Transplant Candidates. J Am Soc Nephrol 2022; 33:2293-2305. [PMID: 36450598 PMCID: PMC9731640 DOI: 10.1681/asn.2022030296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/12/2022] [Accepted: 07/25/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In single-center studies, HLA-DQ mismatches stimulate the most pathogenic donor-specific antibodies. However, because of limitations of transplant registries, this cannot be directly confirmed with registry-based analyses. METHODS We evaluated patients in the Scientific Registry of Transplant Recipients who were relisted after renal graft failure with new, unacceptable antigens corresponding to the HLA typing of their previous donor (UA-PD) as a proxy for donor-specific antibodies. Linear regression was applied to estimate the effects of HLA mismatches on UA-PD and the effects of UA-PD on calculated panel reactive antibody (cPRA) values for 4867 kidney recipients from 2010 to 2021. RESULTS Each additional HLA-DQ mismatch increased the probability of UA-PD by 25.2% among deceased donor transplant recipients and by 28.9% among living donor transplant recipients, significantly more than all other HLA loci (P<0.05). HLA-DQ UA-PD increased cPRA by 29.0% in living donor transplant recipients and by 23.5% in deceased donor transplant recipients, significantly more than all loci except for HLA-A in deceased donor transplant recipients (23.1%). African American deceased donor transplant recipients were significantly more likely than Hispanic and White recipients to develop HLA-DQ UA-PD; among living donor transplant recipients, African American or Hispanic recipients were significantly more likely to do so compared with White recipients. Models evaluating interactions between HLA-DR/DQ mismatches revealed largely independent effects of HLA-DQ mismatches on HLA-DQ UA-PD. CONCLUSIONS HLA-DQ mismatches had the strongest associations with UA-PD, an effect that was greatest in African American and Hispanic recipients. cPRA increases with HLA-DQ UA-PD were equivalent or larger than any other HLA locus. This suggests a need to consider the effects of HLA-DQ in kidney allocation.
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Affiliation(s)
- Dylan Isaacson
- Comprehensive Transplant Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael W. Gmeiner
- Department of Economics, London School of Economics, London, United Kingdom
| | - Hannah C. Copley
- Department of Surgery, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, United Kingdom
| | - Anat R. Tambur
- Comprehensive Transplant Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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17
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Barah M, Kilambi V, Friedewald JJ, Mehrotra S. Implications of Accumulated Cold Time for US Kidney Transplantation Offer Acceptance. Clin J Am Soc Nephrol 2022; 17:1353-1362. [PMID: 35868843 PMCID: PMC9625102 DOI: 10.2215/cjn.01600222] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 02/07/2022] [Revised: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Reducing discard is important for the US transplantation system because nearly 20% of the deceased donor kidneys are discarded. One cause for the discards is the avoidance of protracted cold ischemia times. Extended cold ischemia times at transplant are associated with additional risk of graft failure and patient mortality. A preference for local (within the same donor service area) or low-Kidney Donor Risk Index organs, the endogeneity of cold ischemia time during organ allocation, and the use of provisional offers all complicate the analysis of cold ischemia times' influence on kidney acceptance decision making. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using January 2018 to June 2019 Organ Procurement and Transplantation Network data, we modeled the probability of accepting an offer for a kidney after provisional acceptance. We use logistic regression that includes cold ischemia time, Kidney Donor Risk Index, and other covariates selected from literature. Endogeneity of cold ischemia time was treated by a two-stage instrumental variables approach. RESULTS Logistic regression results for 3.33 million provisional acceptances from 12,369 donors and 108,313 candidates quantify trade-offs between cold ischemia time at the time of offer acceptance and donor-recipient characteristics. Overall, each additional 2 hours of cold ischemia time affected acceptance for nonlocal and local recipients (odds ratio, 0.75; 95% confidence interval, 0.73 to 0.77, odds ratio, 0.88; 95% confidence interval, 0.86 to 0.91; P<0.001). For Kidney Donor Risk Index >1.75 (Kidney Donor Profile Index >85) kidneys, an additional 2 hours of cold ischemia time for nonlocal and local recipients was associated with acceptance with odds ratio, 0.58; 95% confidence interval, 0.54 to 0.63 (nonlocal) and odds ratio, 0.65; 95% confidence interval, 0.6 to 0.7 (local); P<0.001. The effect of an additional 2 hours of cold ischemia time on acceptance of kidneys with Kidney Donor Risk Index ≤1.75 (Kidney Donor Profile Index ≤85) was less pronounced for nonlocal offers (odds ratio, 0.82; 95% confidence interval, 0.80 to 0.85; P<0.001) and not significant for local offers. CONCLUSIONS The acceptability of marginal organs was higher when placements were nearer to the donor and when cold ischemia time was shorter.
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Affiliation(s)
- Masoud Barah
- Department of Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois
| | - Vikram Kilambi
- Department of Engineering and Applied Sciences, RAND Corporation, Arlington, Virginia
- RAND Health Care, Access and Delivery Program, RAND Corporation, Arlington, Virginia
| | - John J Friedewald
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Nephrology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Sanjay Mehrotra
- Department of Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois
- Center for Engineering and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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18
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Giarratano Y, Pugh D, Farrah TE, Oniscu GC, MacGillivray TJ, Dhillon B, Dhaun N, Bernabeu MO. Novel retinal vascular phenotypes for the potential assessment of long-term risk in living kidney donors. Kidney Int 2022; 102:661-665. [PMID: 35810879 DOI: 10.1016/j.kint.2022.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/16/2022] [Indexed: 01/23/2023]
Affiliation(s)
- Ylenia Giarratano
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Dan Pugh
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tariq E Farrah
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Neeraj Dhaun
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK; Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Miguel O Bernabeu
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK; The Bayes Centre, University of Edinburgh, Edinburgh, UK.
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19
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Engels EA, Fraser GE, Kasiske BL, Snyder JJ, Utt J, Lynch CF, Li J, Pawlish KS, Brown S, Yu KJ, Pfeiffer RM. Cancer risk in living kidney donors. Am J Transplant 2022; 22:2006-2015. [PMID: 35510728 PMCID: PMC9357116 DOI: 10.1111/ajt.17082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/03/2022] [Revised: 04/03/2022] [Accepted: 04/25/2022] [Indexed: 01/25/2023]
Abstract
Living kidney donors are screened for transmissible diseases including cancer. Outcomes following donation are excellent, but concern exists regarding development of chronic kidney disease, and cancer risk is unknown. We used linked transplant and cancer registry data to identify incident cancers among 84,357 kidney donors in the United States (1995-2017). We compared risk with the general population using standardized incidence ratios (SIRs). For selected cancers, we used Poisson regression to compare donors with 47,451 Adventist Health Study 2 (AHS-2) participants, who typically have healthy lifestyles. During follow-up, 2843 cancers were diagnosed in donors, representing an overall deficit (SIR 0.79, 95%CI 0.76-0.82). None of 46 specified cancer sites occurred in excess relative to the general population, and 15 showed significant deficits (SIR < 1.00). Compared with AHS-2 participants, donors had similar incidence of liver cancer, melanoma, breast cancer, and non-Hodgkin lymphoma but, starting 7 years after donation, elevated incidence of colorectal cancer (adjusted incidence rate ratio 2.07, 95%CI 1.54-2.79) and kidney cancer (2.97, 1.58-5.58, accounting for the presence of a single kidney in donors). Elevated kidney cancer incidence may reflect adverse processes in donors' remaining kidney. Nonetheless, cancer risk is lower than in the general population, suggesting that enhanced screening is unnecessary.
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Affiliation(s)
- Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Gary E Fraser
- School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - Bertram L Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
| | - Jason Utt
- Research Affairs, Loma Linda University, Loma Linda, California, USA
| | - Charles F Lynch
- Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Jie Li
- Department of Health, Cancer Epidemiology Services, Trenton, New Jersey, USA
| | - Karen S Pawlish
- Department of Health, Cancer Epidemiology Services, Trenton, New Jersey, USA
| | - Sandra Brown
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Kelly J Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
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20
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Gandolfini I, Crespo M, Hellemans R, Maggiore U, Mariat C, Mjoen G, Oniscu GC, Peruzzi L, Sever MS, Watschinger B, Hilbrands L. Issues regarding COVID-19 in kidney transplantation in the era of the omicron variant: a commentary by the era descartes working group. Nephrol Dial Transplant 2022; 37:1824-1829. [PMID: 35746885 PMCID: PMC9278231 DOI: 10.1093/ndt/gfac203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Indexed: 11/20/2022] Open
Abstract
The Omicron variant, which has become the dominant strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide, brings new challenges to preventing and controlling the infection. Moreover, the widespread implementation of vaccination policies before and after transplantation, and the development of new prophylactic and treatment strategies for coronavirus disease 2019 (COVID-19) over the past 12–18 months, has raised several new issues concerning kidney transplant recipients. In this special report, the ERA DESCARTES (Developing Education Science and Care for Renal Transplantation in European States) Working Group addresses several questions related to everyday clinical practice concerning kidney transplant recipients and to the assessment of deceased and live kidney donors: what is the current risk of severe disease and of breakthrough infection, the optimal management of immunosuppression in kidney transplant recipients with COVID-19, the role of passive immunization and the efficacy of antiviral drugs in ambulatory patients, the management of drug-to-drug interactions, safety criteria for the use of SARS-CoV-2-positive donors, issues related to the use of T cell depleting agents as induction treatment, and current recommendations for shielding practices.
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Affiliation(s)
- Ilaria Gandolfini
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Rachel Hellemans
- Laboratory of Experimental Medicine and Pediatrics, Department of Nephrology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Christophe Mariat
- Department of Nephrology, Dialysis and Renal transplantation, Centre Hospitalier Universitaire de Saint Etienne, Université Jean MONNET, Saint Etienne, France
| | - Geir Mjoen
- Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mehmet Sükrü Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Bruno Watschinger
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
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21
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Singh G, Gohh R, Clark D, Kalra K, Das M, Bradauskaite G, Bleyer AJ, Tanriover B, Chang AR, Anand PM. Vignette-Based Reflections to Inform Genetic Testing Policies in Living Kidney Donors. Genes (Basel) 2022; 13. [PMID: 35456398 DOI: 10.3390/genes13040592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 01/01/2023] Open
Abstract
Family history of kidney disease increases risk of end-stage kidney disease (ESKD) in donors. Pre-donation genetic testing is recommended in evaluation guidelines and regulatory policy. Collaborating across several institutions, we describe cases to illustrate the utility as well as practical issues in incorporating genetic testing in transplant protocols. Case 1 is from 2009, before pervasive genetic testing. A healthy 27-year-old Caucasian male had an uneventful donor evaluation for his mother, who had early onset ESKD of unclear cause. He participated in paired-exchange kidney donation, but developed progressive kidney disease and gout over the next 10 years. A uromodulin gene mutation (NM_003361.3(UMOD):c.377 G>A p.C126Y) was detected and kidney biopsy showed tubulointerstitial kidney disease. The patient subsequently required kidney transplantation himself. Case 2 was a 36-year-old African American female who had an uneventful kidney donor evaluation. She underwent gene panel-based testing to rule out ApolipoproteinL1 risk variants, for which was negative. Incidentally, a sickle-cell trait (NM_000518.5(HBB):c.20A>T p.Glu7Val) was noted, and she was declined for kidney donation. This led to significant patient anguish. Case 3 was a 26-year-old Caucasian female who underwent panel-based testing because the potential recipient, her cousin, carried a variant of uncertain significance in the hepatocyte nuclear factor-1-β (HNF1B) gene. While the potential donor did not harbor this variant, she was found to have a likely pathogenic variant in complement factor I (NM_000204.4(CFI):c.1311dup:p.Asp438Argfs*8), precluding kidney donation. Our cases emphasize that while genetic testing can be invaluable in donor evaluation, transplant centers should utilize detailed informed consent, develop care pathways for secondary genetic findings, and share experience to develop best practices around genetic testing in donors.
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22
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El-Bandar N, Lerchbaumer MH, Peters R, Maxeiner A, Kotsch K, Sattler A, Miller K, Schlomm T, Hamm B, Budde K, Liefeldt L, Fischer T, Friedersdorff F. Kidney Perfusion in Contrast-Enhanced Ultrasound (CEUS) Correlates with Renal Function in Living Kidney Donors. J Clin Med 2022; 11:791. [PMID: 35160243 DOI: 10.3390/jcm11030791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 01/22/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is a widely used diagnostic tool for analyzing perfusion and characterizing lesions in several organs. However, to date, it has not been sufficiently investigated whether there is an association between CEUS findings and kidney function. This study aimed at identifying the potential relationship between kidney function and the renal perfusion status determined by CEUS in living kidney donors. A total of 30 living kidney donors examined between April 2018 and March 2020 were included in the study. All patients underwent various diagnostic procedures for evaluation of renal function. CEUS was performed in all 30 donors one day before nephrectomy. Kidney perfusion was quantified using a postprocessing tool (VueBox, Bracco Imaging). Various perfusion parameters were subsequently analyzed and compared with the results of the other methods used to evaluate kidney function. Of all parameters, mean signal intensity (MeanLin) had the strongest correlation, showing significant correlations with eGFR (CG) (r = −0.345; p = 0.007) and total kidney volume (r = −0.409; p = 0.001). While there was no significant correlation between any perfusion parameter and diethylenetriaminepentaacetic acid (DTPA), we detected a significant correlation between MeanLin and DTPA (r = −0.502; p = 0.005) in the subgroup of normal-weight donors. The results indicate that signal intensity in CEUS is associated with kidney function in normal-weight individuals. Body mass index (BMI) may be a potential confounder of signal intensity in CEUS. Thus, more research is needed to confirm these results in larger study populations.
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Spoon EQW, Kortram K, Ismail SY, Nieboer D, d’Ancona FCH, Christiaans MHL, Dam RE, Hofker HS, Hoksbergen AWJ, van der Pant KA, Toorop RJ, van de Wetering J, Ijzermans JNM, Dor FJMF. Living Kidney Donor Knowledge of Provided Information and Informed Consent: The PRINCE Study. J Clin Med 2022; 11:jcm11030698. [PMID: 35160147 PMCID: PMC8837079 DOI: 10.3390/jcm11030698] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Informed consent for living kidney donation is paramount, as donors are healthy individuals undergoing surgery for the benefit of others. The informed consent process for living kidney donors is heterogenous, and the question concerns how well they are actually informed. Knowledge assessments, before and after donor education, can form the basis for a standardized informed consent procedure for live kidney donation. Methods: In this prospective, a multicenter national cohort study conducted in all eight kidney transplant centers in The Netherlands, we assessed the current status of the informed consent practice for live donor nephrectomy. All of the potential living kidney donors in the participating centers were invited to participate. They completed a pop quiz during their first outpatient appointment (Cohort A). Living kidney donors completed the same pop quiz upon admission for donor nephrectomy (Cohort B). Results: In total, 656 pop quizzes were completed (417 in Cohort A, and 239 in Cohort B). The average donor knowledge score was 7.0/25.0 (±3.9, range 0–18) in Cohort A, and 10.5/25.0 (±2.8, range 0–17.5) in Cohort B. Cohort B scored significantly higher on overall knowledge, preparedness, and the individual item scores (p < 0.0001), except for the long-term complications (p = 0.91). Conclusions: Donor knowledge generally improves during the live donor workup, but it is still quite disappointing. Long-term complications, especially, deserve more attention during living kidney donor education.
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Affiliation(s)
- Emerentia Q. W. Spoon
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
| | - Kirsten Kortram
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
| | - Sohal Y. Ismail
- Erasmus MC University Medical Centre, Department of Psychiatry, 3015 GD Rotterdam, The Netherlands;
| | - Daan Nieboer
- Erasmus MC University Medical Centre, Department of Public Health, 3015 GD Rotterdam, The Netherlands;
| | - Frank C. H. d’Ancona
- Radboud University Medical Centre, Department of Urology, 6525 GA Nijmegen, The Netherlands;
| | - Maarten H. L. Christiaans
- Maastricht University Medical Centre, Department of Internal Medicine, 6229 HX Maastricht, The Netherlands;
| | - Ruth E. Dam
- Leiden University Medical Centre, Department of Nephrology, 2333 ZA Leiden, The Netherlands;
| | - Hendrik Sijbrand Hofker
- University Medical Centre Groningen, Department of Surgery, 9713 GZ Groningen, The Netherlands;
| | | | - Karlijn Ami van der Pant
- Amsterdam University Medical Centre, Renal Transplant Unit, Department of Internal Medicine, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam University Medical Centre, Renal Transplant Unit, Department of Nephrology, 1105 AZ Amsterdam, The Netherlands
| | - Raechel J. Toorop
- Utrecht University Medical Centre, Department of Surgery, 3584 CX Utrecht, The Netherlands;
| | | | - Jan N. M. Ijzermans
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
| | - Frank J. M. F. Dor
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
- Correspondence:
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Kaul A, Bhaduaria D, Yachha M, Behera MR, Kushwaha R, Prasad N, Patel MR, Srivastava A. Impact of Kidney Donation on Pregnancy Outcomes: A Retrospective Analysis. Indian J Nephrol 2022; 32:439-444. [PMID: 36568592 PMCID: PMC9775616 DOI: 10.4103/ijn.ijn_411_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction Recent data suggest a risk of gestational hypertension, proteinuria and pre-eclampsia among pregnancies after kidney donation. Methods This retrospective study among females who donated kidneys (1997-2017) at a tertiary renal transplant center in Northern India assessed the maternal and fetal outcomes of their pregnancy. Data of participants were collected using pre-tested semi structured questionnaire. Results In total, 925 female kidney donors (1332 pregnancies) in the pre-donation group and 45 females (48 pregnancies) in the post donation period were included. The mean age of first pregnancy, weight (kg) gain, proportion of history of pre-natal check-up, institutional delivery, and history of unrelated donation was statically significant among the post-donation group. The proportion of pre-eclampsia, gestational hypertension, gestational diabetes, and post-partum hemorrhage was insignificantly higher among the post-donation group with higher preterm birth with low-birth-weight babies. Proteinuria (P < 0.05) was significantly higher among post donation pregnancies. In multivariate analysis, cesarean delivery and low birth weight (<2500 g) were common among the post-donation pregnancy group. Conclusions The study demonstrated no significant risk to maternal outcomes butan increased risk to fetal outcomes in terms of prematurity and low birth weight among the post-donation pregnancy group.
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Affiliation(s)
- Anupma Kaul
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India,Address for correspondence: Dr. Anupma Kaul, Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India. E-mail:
| | - Dharmendra Bhaduaria
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Monika Yachha
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Manas Ranjan Behera
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Ravi Kushwaha
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Manas Ranjan Patel
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
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25
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Ibrahim HN, Murad DN, Hebert SA, Adrogue HE, Nguyen H, Nguyen DT, Matas AJ, Graviss EA. Intermediate Renal Outcomes, Kidney Failure, and Mortality in Obese Kidney Donors. J Am Soc Nephrol 2021; 32:2933-2947. [PMID: 34675059 PMCID: PMC8806092 DOI: 10.1681/asn.2021040548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/04/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Obesity is associated with the two archetypal kidney disease risk factors: hypertension and diabetes. Concerns that the effects of diabetes and hypertension in obese kidney donors might be magnified in their remaining kidney have led to the exclusion of many obese candidates from kidney donation. METHODS We compared mortality, diabetes, hypertension, proteinuria, reduced eGFR and its trajectory, and the development of kidney failure in 8583 kidney donors, according to body mass index (BMI). The study included 6822 individuals with a BMI of <30 kg/m2, 1338 with a BMI of 30-34.9 kg/m2, and 423 with a BMI of ≥35 kg/m2. We used Cox regression models, adjusting for baseline covariates only, and models adjusting for postdonation diabetes, hypertension, and kidney failure as time-varying covariates. RESULTS Obese donors were more likely than nonobese donors to develop diabetes, hypertension, and proteinuria. The increase in eGFR in obese versus nonobese donors was significantly higher in the first 10 years (3.5 ml/min per 1.73m2 per year versus 2.4 ml/min per 1.73m2 per year; P<0.001), but comparable thereafter. At a mean±SD follow-up of 19.3±10.3 years after donation, 31 (0.5%) nonobese and 12 (0.7%) obese donors developed ESKD. Of the 12 patients with ESKD in obese donors, 10 occurred in 1445 White donors who were related to the recipient (0.9%). Risk of death in obese donors was not significantly increased compared with nonobese donors. CONCLUSIONS Obesity in kidney donors, as in nondonors, is associated with increased risk of developing diabetes and hypertension. The absolute risk of ESKD is small and the risk of death is comparable to that of nonobese donors.
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Affiliation(s)
| | - Dina N. Murad
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Sean A. Hebert
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | | | - Hana Nguyen
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Duc T. Nguyen
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, Texas
| | - Arthur J. Matas
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Edward A. Graviss
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, Texas
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
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26
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Park S, Park J, Kang E, Lee JW, Kim Y, Park M, Kim K, Kim HJ, Han M, Cho JH, Lee JP, Lee S, Kim SW, Park SM, Chae DW, Chin HJ, Kim YC, Kim YS, Choi I, Lee H. Economic Impact of Donating a Kidney on Living Donors: A Korean Cohort Study. Am J Kidney Dis 2021; 79:175-184.e1. [PMID: 34419516 DOI: 10.1053/j.ajkd.2021.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/13/2020] [Accepted: 07/04/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Although existing studies have reported adverse health outcomes after kidney donation, its socioeconomic impact on living donors requires further study. STUDY DESIGN A retrospective observational cohort study including a matched comparison group. SETTING & PARTICIPANTS 1,285 living kidney donors from 7 tertiary hospitals between 2003 and 2016, and a matched comparison group consisting of the same number of health screening examinees with similar baseline clinical characteristics and socioeconomic status. All participants were receiving Korean national health insurance. EXPOSURE Kidney donation as reflected in the Korean National Health Insurance System (NHIS) database. OUTCOME Changes in household economic status estimated by Korean national health insurance fees and changes in employment status reflected in the NHIS database. ANALYTICAL APPROACH The outcomes of the donor group and matched control group were compared annually using multivariable logistic regression analyses adjusted for clinical and demographic characteristics. RESULTS The median ages of the donors and matched controls were 45 and 46 years, respectively; 44.6% of both groups were male. Compared to the comparison group, living donors were at higher risk of being unemployed or losing employment during the first 2 years after donation (eg, first-year loss of employment: odds ratio (OR), 2.27 [95% CI, 1.55-3.33]); however, this association did not persist. Donors also had a significantly lower odds of improvement in economic status (OR, 0.57 [95% CI, 0.47-0.71]) and a higher odds of deterioration in financial status (OR, 1.54 [95% CI, 1.23-1.93]) in the first year after transplantation and subsequently. LIMITATIONS Unmeasured differences between donors and matched controls creating residual selection bias and confounding. CONCLUSIONS Living kidney donors may suffer loss of employment and poor economic status after their voluntary donation. The socioeconomic impact on these donors should be considered in conjunction with the potential long-term adverse health outcomes after donation.
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Affiliation(s)
- Sehoon Park
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jina Park
- Department of Biostatistics, College of Medicine, Korea University, Seoul, South Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jang Wook Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Yaerim Kim
- Department of Internal Medicine, School of Medicine, Keimyung University, Daegu, South Korea
| | - Minsu Park
- Department of Information and Statistics, Chungnam National University, Daejeon, Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University, Seoul, South Korea
| | - Hyo Jeong Kim
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Miyeun Han
- Department of Internal Medicine, Pusan National University Hospital, Pusan, South Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University, Daegu, South Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Boramae Medical Center, Seoul National University, Seoul, South Korea
| | - Sik Lee
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, South Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Sang Min Park
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ho Jun Chin
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong Chul Kim
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Insun Choi
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Hajeong Lee
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea.
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Abstract
The Independent Living Donor Advocate, who is required on the transplant team, advocates, promotes, and protects the interests of the donor. Previously described ethical challenges perceived by these advocates and the variability of their responses prompted further inquiry. RESEARCH QUESTIONS How are ethical obligations perceived by ILDAs? What ethical principles do ILDAs identify as the basis of their decision making? What are the ethical challenges for ILDAs? STUDY DESIGN A descriptive cross-sectional survey was designed and administered via REDCap. Participants were recruited from the National Kidney Foundation Living Donor Advocate email list. Quantitative and qualitative data on their role, ethical decision making, and perceived ethical issues, by seriousness and frequency, were collected. RESULTS Thirty-four participants responded. Nonmaleficence was ranked as the primary ethical principle used in decision making. Participants rated obligations to protect higher than advocacy. Participants reported experiencing internal ethical conflict to protect over advocate for the donor. The most serious ethical challenge participants perceived for donors was their decisional capacity, followed by their emotional or psychological distress, which was also described as a frequent donor challenge experienced in their role. DISCUSSION The results of this survey validate previous descriptions that the advocate role is largely perceived as protective. Their independent nature as well as the inherent vulnerabilities of the potential living donor compels the continued mitigation of ethical challenges, to enhance advocacy and protection for the living donor.
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Affiliation(s)
- Sarah B Vittone
- School of Nursing and Health Studies, 8368Georgetown University, Washington, DC, USA
| | - Nancy A Crowell
- School of Nursing and Health Studies, 8368Georgetown University, Washington, DC, USA
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Abstract
Effective altruism is a growing philosophical and social movement, whose members design their lives in ways aligned with doing the most good that they can do. The main focus of this paper is to explore what effective altruism has to say about the moral obligations people have to do good with their organs, in the face of an organ-shortage problem. It is argued that an effective altruism framework offers a number of valuable theoretical and practical insights relevant to ongoing debate about how to resolve the organ-shortage problem. Its recommendations constitute a plausible and promising strategy for increasing the supply of, and decreasing the demand for, human organs, in a way that protects (rather than ignores, or preys upon) the global poor. And, many of its recommendations can be implemented into policy without requiring that citizens actually become effective altruists themselves.
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Affiliation(s)
- Ryan Tonkens
- Lakehead University, Thunder Bay, Ontario, Canada
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29
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Sharaan R, Alsulami S, Arab R, Alzeair G, Elamin N, Alsaywid B, Lytras M. Knowledge, Attitude, and Willingness Toward Kidney Donation Among Health Sciences Students at King Saud Bin Abdulaziz University. Front Public Health 2021; 9:667582. [PMID: 34164369 PMCID: PMC8215665 DOI: 10.3389/fpubh.2021.667582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background: End-stage renal disease, as one of the most serious and major health problems, does not have many treatment options available. One of the best treatment modalities used to cure this debilitating disease is kidney transplantation. However, with the continuous increase in number of patients diagnosed with it, there is not enough supply of the organ. The aim of our study is to assess knowledge about, attitude toward, and willingness to donate kidney among health science students at King Saud bin Abdulaziz University in comparison to the general population in Jeddah and to investigate the factors that play a role on their willingness. Methods: This is an observational, analytical, cross-sectional study design conducted in 2019. Two target populations were included: King Saud bin Abdulaziz University for Health Sciences students and the general population in Jeddah. Data were collected via a self-administered, close-ended, structured, and previously validated questionnaire that contained 39 items divided into four sections. SPSS program version 22 was used in data analysis. Results: Out of 685 surveyed participants, 179 (26.1%) were willing to donate their kidney, with students showing a higher rate of willingness (N = 101; 32.3%) than the general population (N = 78; 21%). However, only 46 (6.7%) out of the total population hold an organ donor card. In bivariate analysis, it was found that knowledge significantly associated with a higher rate of willingness among the student population than the general population, while positive beliefs were associated with increased willingness in the general population than students. Positive attitude appeared to play a role in higher willingness among the general population and student population. Conclusion: There is a low perception of awareness regarding kidney donation in both populations of this study. The willingness rate of health science students at King Saud bin Abdulaziz University and the general population was low when compared with other studies conducted internationally.
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Affiliation(s)
- Raghad Sharaan
- King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, Saudi Arabia
| | - Sara Alsulami
- King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, Saudi Arabia
| | - Raneem Arab
- King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, Saudi Arabia
| | - Ghida Alzeair
- King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, Saudi Arabia
| | - Nadia Elamin
- King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, Saudi Arabia
| | - Basim Alsaywid
- Urology Section, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard, Jeddah, Saudi Arabia.,Planning and Organizational Excellence Administration, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - Miltiadis Lytras
- Effat College of Engineering, Effat University, Jeddah, Saudi Arabia.,Distinguished Scientists Program, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
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30
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Tarabeih M, Bokek-Cohen Y. The double gender bias in parental kidney donation among Muslim Arab patients. Nurs Inq 2021; 28:e12410. [PMID: 33886149 DOI: 10.1111/nin.12410] [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: 01/07/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 11/27/2022]
Abstract
Previous studies showed that it is usually the mother who agrees to donate her kidney to a child with an end-stage renal disease, while the fathers tend much less to donate. The present study sought to explore decision-making regarding which parent would donate a kidney to their child. Interviews were conducted with twenty-five mothers and six fathers who donated a kidney to their child. Analysis of the narratives reveals unwillingness to donate a kidney to a sick daughter and five reasons why mothers are more willing to donate than fathers. Our study shows that parents' patterns of kidney donation to their children powerfully demonstrate gender relations in Arab society and that culturally related matters have a significant impact on human organ transplantation, hence on quality of life and the chances of survival of nephrological pediatric patients. We recommend that the nursing staff enlist the help of Muslim clerics to increase the willingness of fathers to donate a kidney, for sons as well as for daughters. We call for designing education campaigns aimed at raising awareness and encouraging changes in the attitudes of the families of pediatric ESRD patients as well as of physicians.
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Affiliation(s)
- Mahdi Tarabeih
- School of Nursing, The Academic College of Tel Aviv Jaffa, Tel Aviv, Israel
| | - Ya'arit Bokek-Cohen
- School of Social Sciences, The Israel Academic College of Ramat Gan, Ramat Gan, Israel
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31
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Haakinson DJ. Time to Procurement and Post-Kidney Transplant Outcomes: How Do We Provide a Personalized Medicine Approach to Optimizing Organ Donation? Clin J Am Soc Nephrol 2021; 16:340-342. [PMID: 33637607 PMCID: PMC8011024 DOI: 10.2215/cjn.01340121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Danielle J Haakinson
- Department of Surgery, Section of Transplantation Surgery and Immunology, Yale University, New Haven, Connecticut
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32
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Haugen AJ, Hallan S, Langberg NE, Dahle DO, Pihlstrøm H, Birkeland KI, Reisæter AV, Midtvedt K, Hartmann A, Holdaas H, Mjøen G. Increased risk of ischemic heart disease after kidney donation. Nephrol Dial Transplant 2021; 37:928-936. [PMID: 33624826 PMCID: PMC9035350 DOI: 10.1093/ndt/gfab054] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background Previous reports suggest increased risk of hypertension and cardiovascular mortality after kidney donation. In this study we investigate the occurrence of ischaemic heart disease and cerebrovascular disease, diabetes and cancer in live kidney donors compared with healthy controls eligible for donation. Methods Different diagnoses were assessed in 1029 kidney donors and 16 084 controls. The diagnoses at follow-up were self-reported for the controls and registered by a physician for the donors. Stratified logistic regression was used to estimate associations with various disease outcomes, adjusted for gender, age at follow-up, smoking at baseline, body mass index at baseline, systolic blood pressure at baseline and time since the donation. Results The mean observation time was 11.3 years [standard deviation (SD) 8.1] for donors versus 16.4 years (SD 5.7) for controls. The age at follow-up was 56.1 years (SD 12.4) in donors versus 53.5 years (SD 11.1) in controls and 44% of donors were males versus 39.3% in the controls. At follow-up, 35 (3.5%) of the donors had been diagnosed with ischaemic heart disease versus 267 (1.7%) of the controls. The adjusted odds ratio for ischaemic heart disease was 1.64 (confidence interval 1.10–2.43; P = 0.01) in donors compared with controls. There were no significant differences for the risks of cerebrovascular disease, diabetes or cancer. Conclusions During long-term follow-up of kidney donors, we found an increased risk of ischaemic heart disease compared with healthy controls. This information may be important in the follow-up and selection process of living kidney donors.
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Affiliation(s)
- Anders J Haugen
- Oslo University Hospital, Rikshospitalet, Dept. of Transplant Medicine, Oslo, Norway.,University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Stein Hallan
- St Olavs Hospital, Dept. of Nephrology, Trondheim, Norway
| | - Nina E Langberg
- Oslo University Hospital, Rikshospitalet, Dept. of Transplant Medicine, Oslo, Norway.,University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Dag Olav Dahle
- Oslo University Hospital, Rikshospitalet, Dept. of Transplant Medicine, Oslo, Norway
| | - Hege Pihlstrøm
- Oslo University Hospital, Rikshospitalet, Dept. of Transplant Medicine, Oslo, Norway
| | - Kåre I Birkeland
- Oslo University Hospital, Rikshospitalet, Dept. of Transplant Medicine, Oslo, Norway.,University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Anna V Reisæter
- Oslo University Hospital, Rikshospitalet, Dept. of Transplant Medicine, Oslo, Norway
| | - Karsten Midtvedt
- Oslo University Hospital, Rikshospitalet, Dept. of Transplant Medicine, Oslo, Norway
| | - Anders Hartmann
- Oslo University Hospital, Rikshospitalet, Dept. of Transplant Medicine, Oslo, Norway
| | - Hallvard Holdaas
- Oslo University Hospital, Rikshospitalet, Dept. of Transplant Medicine, Oslo, Norway
| | - Geir Mjøen
- Oslo University Hospital, Rikshospitalet, Dept. of Transplant Medicine, Oslo, Norway
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33
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Affiliation(s)
- Monica Fox
- Outreach and Government Relations, National Kidney Foundation of Illinois, Chicago, Illinois
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34
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Punjala SR, Adamjee Q, Silas L, Gökmen R, Karydis N. Weight trends in living kidney donors suggest predonation counselling alone lacks a sustainable effect on weight loss: a single centre cohort study. Transpl Int 2021; 34:514-524. [PMID: 33423338 DOI: 10.1111/tri.13816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/30/2020] [Revised: 09/17/2020] [Accepted: 01/07/2021] [Indexed: 12/27/2022]
Abstract
Living kidney donors are at risk of long-term end-stage renal disease, and obesity is an independent risk factor. In our centre, predonation counselling of obese donors concentrates on lifestyle modifications, particularly weight loss and exercise. Whether these recommendations have a sustainable effect after donation remains unknown. We conducted a retrospective analysis of all donors who proceeded to donation between 2012 and 2016. Donors' body mass index (BMI) was compared between predefined time points using matched pair analysis. Among 303 donors included, 15% were obese at initial assessment. Obese donors were observed to lose weight by the time of donation (mean BMI difference 1.32 kg/m2 , P < 0.001), but bounced back to their initial weight at one-year postdonation (mean BMI difference + 1.47 kg/m2 , P < 0.001), which was maintained at two-year postdonation. While 71% of obese donors lost weight by the time of donation, 56% of them gained that weight back at one year. Our findings underline the success of predonation counselling on lifestyle modification in highly motivated obese donors, although additional strategies are required to sustain weight loss. The impact of weight gain on long-term risk needs further evaluation. Living donor programmes should provide continued support with lifestyle modifications after donation.
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Affiliation(s)
- Sai Rithin Punjala
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Qainat Adamjee
- GKT School of Medical Education, King's College London, London, UK
| | - Lisa Silas
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Refik Gökmen
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nikolaos Karydis
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,GKT School of Medical Education, King's College London, London, UK
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35
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Hart A, Lentine KL, Smith JM, Miller JM, Skeans MA, Prentice M, Robinson A, Foutz J, Booker SE, Israni AK, Hirose R, Snyder JJ. OPTN/SRTR 2019 Annual Data Report: Kidney. Am J Transplant 2021; 21 Suppl 2:21-137. [PMID: 33595191 DOI: 10.1111/ajt.16502] [Citation(s) in RCA: 238] [Impact Index Per Article: 79.3] [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: 01/25/2023]
Abstract
Despite the ongoing severe shortage of available kidney grafts relative to candidates in need, data from 2019 reveal some promising trends. After remaining relatively stagnant for many years, the number of kidney transplants has increased each year since 2015, reaching the highest annual count to date of 24,273 in 2019. The number of patients waiting for a kidney transplant in the United States was relatively stable, despite an increase in the number of new candidates added in 2019 and a decrease in patients removed from the waiting list owing to death or deteriorating medical condition. However, these encouraging trends are tempered by ongoing challenges. Nationwide, only a quarter of waitlisted patients receive a deceased-donor kidney transplant within 5 years, and this proportion varies dramatically by donation service area, from 15.5% to 67.8%. The non-utilization (discard) rate of recovered organs remains at 20.1%, despite adramatic decline in the discard of organs from hepatitis C-positive donors. Non-utilization rates remain particularly high for Kidney Donor Profile Index ≥85% kidneys and kidneys from which a biopsy specimen was obtained. While the number of living-donor transplants increased again in 2019, only a small proportion of the waiting list receives living-donor transplants each year, and racial disparities in living-donor transplant access persist. As both graft and patient survival continue to improve incrementally, the total number of living kidney transplant recipients with a functioning graft is anticipated to exceed 250,000 in the next 1-2 years. Over the past decade, the total number of pediatric kidney transplants performed has remained stable. Despite numerous efforts, living donor kidney transplant remains low among pediatric recipients with continued racial disparities among recipients. Congenital anomalies of the kidney and urinary tract remain the leading cause of kidney disease. While most deceased donor recipients receive a kidney from a donor with KDPI less than 35%, the majority of pediatric recipients had four or more HLA mismatches. Graft survival continues to improve with superior outcomes for living donor recipients.
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Affiliation(s)
- A Hart
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
| | - K L Lentine
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - J M Smith
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Pediatrics, University of Washington, Seattle, WA
| | - J M Miller
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - M A Skeans
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - M Prentice
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - A Robinson
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - J Foutz
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - S E Booker
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - A K Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - R Hirose
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department Surgery, University of California San Francisco, San Francisco, CA
| | - J J Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
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36
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Affiliation(s)
- Elise F Palzer
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Shruti Vempati
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Erika S Helgeson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Arthur J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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37
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Habbous S, Barnieh L, Litchfield K, McKenzie S, Reich M, Lam NN, Mucsi I, Bugeja A, Yohanna S, Mainra R, Chong K, Fantus D, Prasad GVR, Dipchand C, Gill J, Getchell L, Garg AX. A RAND-Modified Delphi on Key Indicators to Measure the Efficiency of Living Kidney Donor Candidate Evaluations. Clin J Am Soc Nephrol 2020; 15:1464-1473. [PMID: 32972951 PMCID: PMC7536753 DOI: 10.2215/cjn.03780320] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/23/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Many patients, providers, and potential living donors perceive the living kidney donor evaluation process to be lengthy and difficult to navigate. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We sought consensus on key terms and process and outcome indicators that can be used to measure how efficiently a transplant center evaluates persons interested in becoming a living kidney donor. Using a RAND-modified Delphi method, 77 participants (kidney transplant recipients or recipient candidates, living kidney donors or donor candidates, health care providers, and health care administrators) completed an online survey to define the terms and indicators. The definitions were then further refined during an in-person meeting with ten stakeholders. RESULTS We identified 16 process indicators (e.g., average time to evaluate a donor candidate), eight outcome indicators (e.g., annual number of preemptive living kidney donor transplants), and two measures that can be considered both process and outcome indicators (e.g., average number of times a candidate visited the transplant center for the evaluation). Transplant centers wishing to implement this set of indicators will require 22 unique data elements, all of which are either readily available or easily collected prospectively. CONCLUSIONS We identified a set of indicators through a consensus-based approach that may be used to monitor and improve the performance of a transplant center in how efficiently it evaluates persons interested in becoming a living kidney donor.
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Affiliation(s)
- Steven Habbous
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada .,Quality, Measurement, and Evaluation, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Lianne Barnieh
- Department of Nephrology, London Health Sciences Centre, London, Ontario, Canada
| | - Kenneth Litchfield
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Canada
| | - Susan McKenzie
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Canada
| | - Marian Reich
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Canada
| | - Ngan N Lam
- Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
| | - Istvan Mucsi
- Kidney Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Ann Bugeja
- Division of Nephrology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Seychelle Yohanna
- Division of Nephrology, McMaster University, Hamilton, Ontario, Canada
| | - Rahul Mainra
- Saskatchewan Transplant Program, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
| | - Kate Chong
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Canada
| | - Daniel Fantus
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - G V Ramesh Prasad
- Kidney Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Christine Dipchand
- Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jagbir Gill
- Division of Nephrology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Leah Getchell
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Canada
| | - Amit X Garg
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Department of Nephrology, London Health Sciences Centre, London, Ontario, Canada
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38
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Ibrahim M, Greenhall GHB, Summers DM, Mumford L, Johnson R, Baker RJ, Forsythe J, Pettigrew GJ, Ahmad N, Callaghan CJ. Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom. Clin J Am Soc Nephrol 2020; 15:1320-1329. [PMID: 32690721 PMCID: PMC7480543 DOI: 10.2215/cjn.02060220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/17/2020] [Accepted: 06/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidneys from elderly deceased donors are often discarded after procurement if the expected outcomes from single kidney transplantation are considered unacceptable. An alternative is to consider them for dual kidney transplantation. We aimed to examine the utilization of kidneys from donors aged ≥60 years in the United Kingdom and compare clinical outcomes of dual versus single kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the United Kingdom Transplant Registry from 2005 to 2017 were analyzed. We examined utilization rates of kidneys retrieved from deceased donors aged ≥60 years, and 5-year patient and death-censored graft survival of recipients of dual and single kidney transplants. Secondary outcomes included eGFR. Multivariable analyses and propensity score analysis were used to correct for differences between the groups. RESULTS During the study period, 7841 kidneys were procured from deceased donors aged ≥60 years, of which 1338 (17%) were discarded; 356 dual and 5032 single kidneys were transplanted. Donors of dual transplants were older (median, 73 versus 66 years; P<0.001) and had higher United States Kidney Donor Risk Indices (2.48 versus 1.98; P<0.001). Recipients of dual transplants were also older (64 versus 61 years; P<0.001) and had less favorable human leukocyte antigen matching (P<0.001). After adjusting for confounders, dual and single transplants had similar 5-year graft survival (hazard ratio, 0.81; 95% CI, 0.59 to 1.12). No difference in patient survival was demonstrated. Similar findings were observed in a matched cohort with a propensity score analysis method. Median 12-month eGFR was significantly higher in the dual kidney transplant group (40 versus 36 ml/min per 1.73 m2; P<0.001). CONCLUSIONS Recipients of kidneys from donors aged ≥60 years have similar 5-year graft survival and better graft function at 12 months with dual compared with single deceased donor kidney transplants.
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Affiliation(s)
- Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom .,National Health Service Blood and Transplant, Bristol, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - George H B Greenhall
- Department of Nephrology and Transplantation, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.,National Health Service Blood and Transplant, Bristol, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Dominic M Summers
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Lisa Mumford
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Rachel Johnson
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Richard J Baker
- Department of Nephrology, St James's University Hospital, The Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - John Forsythe
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Gavin J Pettigrew
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Niaz Ahmad
- Department of Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Chris J Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.,National Health Service Blood and Transplant, Bristol, United Kingdom
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39
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Jehn U, Görlich D, Reuter S. The Estimation Formula for the Urinary Albumin-Creatinine Ratio Based on the Protein-Creatinine Ratio Are Not Valid for a Kidney Transplant and a Living Donor Cohort. J Am Soc Nephrol 2020; 31:1915-1916. [PMID: 32737207 DOI: 10.1681/asn.2020050545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ulrich Jehn
- Division of General Internal Medicine, Department of Medicine D, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Hospital of Münster, Münster, Germany
| | - Stefan Reuter
- Division of General Internal Medicine, Department of Medicine D, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany
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40
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Anderson J, Britt RK, Britt BC, Harming S, Fahrenwald N. Native Americans' Memorable Conversations About Living Kidney Donation and Transplant. Qual Health Res 2020; 30:679-692. [PMID: 31679506 DOI: 10.1177/1049732319882672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Living kidney donation and transplant (LKDT) offers a path of hope for patients on indefinite dialysis treatment. However, identification of a living donor can be challenging; initiating these conversations is difficult. Our study analyzes memorable conversations about LKDT that occurred in response to an LKDT campaign targeted to Native Americans. Our analysis of n = 28 memorable conversations revealed that the campaign prompted conversations and increased communication efficacy about LKDT. Based on these findings, we suggest that campaign designers utilize narratives within campaigns to model communication self-efficacy and then analyze the content of postcampaign conversations as an indicator of campaign effectiveness.
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Affiliation(s)
- Jenn Anderson
- South Dakota State University, Brookings, South Dakota, USA
| | | | - Brian C Britt
- South Dakota State University, Brookings, South Dakota, USA
| | - Shana Harming
- South Dakota State University, Brookings, South Dakota, USA
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41
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Leeser DB, Thomas AG, Shaffer AA, Veale JL, Massie AB, Cooper M, Kapur S, Turgeon N, Segev DL, Waterman AD, Flechner SM. Patient and Kidney Allograft Survival with National Kidney Paired Donation. Clin J Am Soc Nephrol 2020; 15:228-237. [PMID: 31992572 PMCID: PMC7015097 DOI: 10.2215/cjn.06660619] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 06/07/2019] [Accepted: 11/14/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In the United States, kidney paired donation networks have facilitated an increasing proportion of kidney transplants annually, but transplant outcome differences beyond 5 years between paired donation and other living donor kidney transplant recipients have not been well described. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using registry-linked data, we compared National Kidney Registry (n=2363) recipients to control kidney transplant recipients (n=54,497) (February 2008 to December 2017). We estimated the risk of death-censored graft failure and mortality using inverse probability of treatment weighted Cox regression. The parsimonious model adjusted for recipient factors (age, sex, black, race, body mass index ≥30 kg/m2, diabetes, previous transplant, preemptive transplant, public insurance, hepatitis C, eGFR, antibody depleting induction therapy, year of transplant), donor factors (age, sex, Hispanic ethnicity, body mass index ≥30 kg/m2), and transplant factors (zero HLA mismatch). RESULTS National Kidney Registry recipients were more likely to be women, black, older, on public insurance, have panel reactive antibodies >80%, spend longer on dialysis, and be previous transplant recipients. National Kidney Registry recipients were followed for a median 3.7 years (interquartile range, 2.1-5.6; maximum 10.9 years). National Kidney Registry recipients had similar graft failure (5% versus 6%; log-rank P=0.2) and mortality (9% versus 10%; log-rank P=0.4) incidence compared with controls during follow-up. After adjustment for donor, recipient, and transplant factors, there no detectable difference in graft failure (adjusted hazard ratio, 0.95; 95% confidence interval, 0.77 to 1.18; P=0.6) or mortality (adjusted hazard ratio, 0.86; 95% confidence interval, 0.70 to 1.07; P=0.2) between National Kidney Registry and control recipients. CONCLUSIONS Even after transplanting patients with greater risk factors for worse post-transplant outcomes, nationalized paired donation results in equivalent outcomes when compared with control living donor kidney transplant recipients.
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Affiliation(s)
- David B Leeser
- Department of Surgery, East Carolina University, Greenville, North Carolina;
| | - Alvin G Thomas
- Department of Surgery and.,Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Ashton A Shaffer
- Department of Surgery and.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Sandip Kapur
- Department of Surgery, Cornell University, New York, New York
| | - Nicole Turgeon
- Department of Surgery, Dell School of Medicine, University of Texas at Austin, Austin, Texas
| | - Dorry L Segev
- Department of Surgery and.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Amy D Waterman
- Department of Nephrology, University of California, Los Angeles, Los Angeles, California.,Terasaki Research Institute, Los Angeles, California; and
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42
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Issa N, Lopez CL, Denic A, Taler SJ, Larson JJ, Kremers WK, Ricaurte L, Merzkani MA, Alexander MP, Chakkera HA, Stegall MD, Augustine JJ, Rule AD. Kidney Structural Features from Living Donors Predict Graft Failure in the Recipient. J Am Soc Nephrol 2020; 31:415-423. [PMID: 31974271 DOI: 10.1681/asn.2019090964] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 09/24/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Nephrosclerosis, nephron size, and nephron number vary among kidneys transplanted from living donors. However, whether these structural features predict kidney transplant recipient outcomes is unclear. METHODS Our study used computed tomography (CT) and implantation biopsy to investigate donated kidney features as predictors of death-censored graft failure at three transplant centers participating in the Aging Kidney Anatomy study. We used global glomerulosclerosis, interstitial fibrosis/tubular atrophy, artery luminal stenosis, and arteriolar hyalinosis to measure nephrosclerosis; mean glomerular volume, cortex volume per glomerulus, and mean cross-sectional tubular area to measure nephron size; and calculations from CT cortical volume and glomerular density on biopsy to assess nephron number. We also determined the death-censored risk of graft failure with each structural feature after adjusting for the predictive clinical characteristics of donor and recipient. RESULTS The analysis involved 2293 donor-recipient pairs. Mean recipient follow-up was 6.3 years, during which 287 death-censored graft failures and 424 deaths occurred. Factors that predicted death-censored graft failure independent of both donor and recipient clinical characteristics included interstitial fibrosis/tubular atrophy, larger cortical nephron size (but not nephron number), and smaller medullary volume. In a subset with 12 biopsy section slides, arteriolar hyalinosis also predicted death-censored graft failure. CONCLUSIONS Subclinical nephrosclerosis, larger cortical nephron size, and smaller medullary volume in healthy donors modestly predict death-censored graft failure in the recipient, independent of donor or recipient clinical characteristics. These findings provide insights into a graft's "intrinsic quality" at the time of donation, and further support the use of intraoperative biopsies to identify kidney grafts that are at higher risk for failure.
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Affiliation(s)
- Naim Issa
- Division of Nephrology and Hypertension.,William J von Liebig Center for Transplantation and Clinical Regeneration
| | | | | | - Sandra J Taler
- Division of Nephrology and Hypertension.,William J von Liebig Center for Transplantation and Clinical Regeneration
| | | | - Walter K Kremers
- William J von Liebig Center for Transplantation and Clinical Regeneration.,Division of Biomedical Statistics and Informatics, and
| | | | | | | | - Harini A Chakkera
- Division of Nephrology, Mayo Clinic Arizona, Scottsdale, Arizona; and
| | - Mark D Stegall
- William J von Liebig Center for Transplantation and Clinical Regeneration
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43
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Hart A, Smith JM, Skeans MA, Gustafson SK, Wilk AR, Castro S, Foutz J, Wainright JL, Snyder JJ, Kasiske BL, Israni AK. OPTN/SRTR 2018 Annual Data Report: Kidney. Am J Transplant 2020; 20 Suppl s1:20-130. [PMID: 31898417 DOI: 10.1111/ajt.15672] [Citation(s) in RCA: 291] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Despite the ongoing severe mismatch between organ need and supply, data from 2018 revealed some promising trends. For the fourth year in a row, the number of patients waiting for a kidney transplant in the US declined and numbers of both deceased and living donor kidney transplants increased. These encouraging trends are tempered by ongoing challenges, such as a large proportion of listed patients with dialysis time longer than 5 years. The proportion of candidates aged 65 years or older continued to rise, and the proportion undergoing transplant within 5 years of listing continued to vary dramatically nationwide, from 10% to nearly 80% across donation service areas. Increasing trends in the recovery of organs from hepatitis C positive donors and donors with anoxic brain injury warrant ongoing monitoring, as does the ongoing discard of nearly 20% of recovered organs. While the number of living donor transplants increased, racial disparities persisted in the proportion of living versus deceased donors. Strikingly, the total number of kidney transplant recipients alive with a functioning graft is on track to pass 250,000 in the next 1-2 years. The total number of pediatric kidney transplants remained steady at 756 in 2018. Deeply concerning to the pediatric community is the persistently low level of living donor kidney transplants, representing only 36.2% in 2018.
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Affiliation(s)
- A Hart
- Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN.,Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - J M Smith
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Pediatrics, University of Washington, Seattle, WA
| | - M A Skeans
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - S K Gustafson
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - A R Wilk
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - S Castro
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - J Foutz
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - J L Wainright
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - J J Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - B L Kasiske
- Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN.,Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - A K Israni
- Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN.,Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
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44
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Asch WS. Is Hypertension Following Donor Nephrectomy Cause For Elevated Living Donor Kidney Function Concern? Clin J Am Soc Nephrol 2019; 14:1427-1429. [PMID: 31591256 PMCID: PMC6777590 DOI: 10.2215/cjn.09650819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- William S Asch
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
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45
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Holscher CM, Haugen CE, Jackson KR, Garonzik Wang JM, Waldram MM, Bae S, Locke JE, Reed RD, Lentine KL, Gupta G, Weir MR, Friedewald JJ, Verbesey J, Cooper M, Segev DL, Massie AB. Self-Reported Incident Hypertension and Long-Term Kidney Function in Living Kidney Donors Compared with Healthy Nondonors. Clin J Am Soc Nephrol 2019; 14:1493-1499. [PMID: 31537534 PMCID: PMC6777600 DOI: 10.2215/cjn.04020419] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/31/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The risk of hypertension attributable to living kidney donation remains unknown as does the effect of developing postdonation hypertension on subsequent eGFR. We sought to understand the association between living kidney donation, hypertension, and long-term eGFR by comparing donors with a cohort of healthy nondonors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We compared 1295 living kidney donors with median 6 years of follow-up with a weighted cohort of 8233 healthy nondonors. We quantified the risk of self-reported hypertension using a parametric survival model. We examined the association of hypertension with yearly change in eGFR using multilevel linear regression and clustering by participant, with an interaction term for race. RESULTS Kidney donation was independently associated with a 19% higher risk of hypertension (adjusted hazard ratio, 1.19; 95% confidence interval, 1.01 to 1.41; P=0.04); this association did not vary by race (interaction P=0.60). For white and black nondonors, there was a mean decline in eGFR (-0.4 and -0.3 ml/min per year, respectively) that steepened after incident hypertension (-0.8 and -0.9 ml/min per year, respectively; both P<0.001). For white and black kidney donors, there was a mean increase in eGFR after donation (+0.4 and +0.6 ml/min per year, respectively) that plateaued after incident hypertension (0 and -0.2 ml/min per year, respectively; P=0.07 and P=0.01, respectively, after hypertension). CONCLUSIONS Kidney donors are at higher risk of hypertension than similar healthy nondonors, regardless of race. Donors who developed hypertension had a plateau in the usual postdonation increase of eGFR.
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Affiliation(s)
- Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine E Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kyle R Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Madeleine M Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Jayme E Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama
| | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Gaurav Gupta
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Matthew R Weir
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - John J Friedewald
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
| | - Jennifer Verbesey
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC
| | - Matthew Cooper
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; .,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
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Kim SJ, Gill JS, Knoll G, Campbell P, Cantarovich M, Cole E, Kiberd B. Referral for Kidney Transplantation in Canadian Provinces. J Am Soc Nephrol 2019; 30:1708-1721. [PMID: 31387925 DOI: 10.1681/asn.2019020127] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 02/08/2019] [Accepted: 05/20/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patient referral to a transplant facility, a prerequisite for dialysis-treated patients to access kidney transplantation in Canada, is a subjective process that is not recorded in national dialysis or transplant registries. Patients who may benefit from transplant may not be referred. METHODS In this observational study, we prospectively identified referrals for kidney transplant in adult patients between June 2010 and May 2013 in 12 transplant centers, and linked these data to information on incident dialysis patients in a national registry. RESULTS Among 13,184 patients initiating chronic dialysis, the cumulative incidence of referral for transplant was 17.3%, 24.0%, and 26.8% at 1, 2, and 3 years after dialysis initiation, respectively; the rate of transplant referral was 15.8 per 100 patient-years (95% confidence interval, 15.1 to 16.4). Transplant referral varied more than three-fold between provinces, but it was not associated with the rate of deceased organ donation or median waiting time for transplant in individual provinces. In a multivariable model, factors associated with a lower likelihood of referral included older patient age, female sex, diabetes-related ESKD, higher comorbid disease burden, longer durations (>12.0 months) of predialysis care, and receiving dialysis at a location >100 km from a transplant center. Median household income and non-Caucasian race were not associated with a lower likelihood of referral. CONCLUSIONS Referral rates for transplantation varied widely between Canadian provinces but were not lower among patients of non-Caucasian race or with lower socioeconomic status. Standardization of transplantation referral practices and ongoing national reporting of referral may decrease disparities in patient access to kidney transplant.
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Affiliation(s)
- S Joseph Kim
- University Health Network, University of Toronto, Toronto, Canada
| | - John S Gill
- University of British Columbia, Vancouver, Canada; .,Division of Nephrology, Center for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | - Greg Knoll
- University of Ottawa, Ottawa, Canada.,Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Edward Cole
- University Health Network, University of Toronto, Toronto, Canada
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Abstract
PURPOSE OF REVIEW The safety of living donor nephrectomy is essential to the continued success, growth, and sustainability of the clinical practice of living donor kidney transplantation. This review summarizes recent advances in our understanding of the perioperative and long-term risks faced by living kidney donors. RECENT FINDINGS Although adverse perioperative complications are extremely rare, donors particularly men, Black, or obese, frequently experience minor complications that result in delayed return to normal duties at home and work. Similarly, although long-term complications such as end-stage renal disease (ESRD) are rare, recent studies suggest a relative increase in risk of ESRD that is attributable to donation. Several risk calculators have been developed to help donors and their care providers quantify the baseline and postdonation risk of ESRD based on demographic and health characteristics. Thresholds of risk may help define what is an acceptable level of risk to the donor and the transplant center. SUMMARY Individualized risk calculators now allow care providers and potential donors to objectively and transparently participate in shared decision-making about the safety of living kidney donation.
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Affiliation(s)
- Luckmini Liyanage
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Abimerki Muzaale
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Macey Henderson
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA
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Affiliation(s)
| | - Philip J Held
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Thomas G Peters
- Department of Surgery, University of Florida, Jacksonville, Florida; and
| | - John P Roberts
- Department of Surgery, University of California, San Francisco, San Francisco, California
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49
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Newell KA, Formica RN. ESKD Risk in Living Kidney Donors "Like Me". Clin J Am Soc Nephrol 2019; 14:970-971. [PMID: 31278113 PMCID: PMC6625628 DOI: 10.2215/cjn.06010519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kenneth A Newell
- Department of Surgery, Section of Transplantation, Emory University School of Medicine, Atlanta, Georgia; and
| | - Richard N Formica
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
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50
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Al Ammary F, Luo X, Muzaale AD, Massie AB, Crews DC, Waldram MM, Qadi MA, Garonzik-Wang J, Henderson ML, Brennan DC, Wiseman AC, Lindrooth RC, Snyder JJ, Coresh J, Segev DL. Risk of ESKD in Older Live Kidney Donors with Hypertension. Clin J Am Soc Nephrol 2019; 14:1048-1055. [PMID: 31239252 PMCID: PMC6625624 DOI: 10.2215/cjn.14031118] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 11/29/2018] [Accepted: 04/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Hypertension in older kidney donor candidates is viewed as safe. However, hypertension guidelines have evolved and long-term outcomes have not been explored. We sought to quantify the 15-year risk of ESKD and mortality in older donors (≥50 years old) with versus those without hypertension. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A United States cohort of 24,533 older donors from 1999 to 2016, including 2265 with predonation hypertension, were linked to Centers for Medicare and Medicaid Services data and the Social Security Death Master File to ascertain ESKD development and mortality. The exposure of interest was predonation hypertension. From 2004 to 2016, hypertension was defined as documented predonation use of antihypertensive therapy, regardless of systolic BP or diastolic BP; from 1999 to 2003, when there was no documentation of antihypertensive therapy, hypertension was defined as predonation systolic BP ≥140 or diastolic BP ≥90 mm Hg. RESULTS Older donors were 82% white, 6% black, 7% Hispanic, and 3% Asian. The median follow-up was 7.1 years (interquartile range, 3.4-11.1; maximum, 18). There were 24 ESKD and 252 death events during the study period. The 15-year risk of ESKD was 0.8% (95% confidence interval [95% CI], 0.4 to 1.6) for donors with hypertension (mean systolic BP, 138 mm Hg) versus 0.2% (95% CI, 0.1 to 0.4) for donors without hypertension (mean systolic BP, 123 mm Hg; adjusted hazard ratio, 3.04; 95% CI, 1.28 to 7.22; P=0.01). When predonation antihypertensive therapy was available, the risk of ESKD was 6.21-fold higher (95% CI, 1.20 to 32.17; P=0.03) for donors using antihypertensive therapy (mean systolic BP, 132 mm Hg) versus those not using antihypertensive therapy (mean systolic BP, 124 mm Hg). There was no significant association between donor hypertension and 15-year mortality (hazard ratio, 1.18; 95% CI, 0.84 to 1.66; P=0.34). CONCLUSIONS Compared with older donors without hypertension, older donors with hypertension had higher risk of ESKD, but not mortality, for 15 years postdonation. However, the absolute risk of ESKD was small.
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Affiliation(s)
| | - Xun Luo
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Allan B Massie
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | - Madeleine M Waldram
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | | | - Macey L Henderson
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alexander C Wiseman
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard C Lindrooth
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado
| | - Jon J Snyder
- Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota; and.,Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Josef Coresh
- Departments of Medicine and.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Dorry L Segev
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.,Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
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