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Melk A, Sugianto RI, Zhang X, Dahhou M, Döhler B, Süsal C, Sapir-Pichhadze R, Wong G, Foster BJ. Influence of donor sex and age on graft outcome in kidney transplantation. Nephrol Dial Transplant 2024; 39:607-617. [PMID: 37596063 DOI: 10.1093/ndt/gfad181] [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: 05/25/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND There is a known recipient sex-dependent association between donor sex and kidney transplant survival. We hypothesized that donor age also modifies the association between donor sex and graft survival. METHODS First, deceased donor kidney transplant recipients (1988-2019, n = 461 364) recorded in the Scientific Registry of Transplant Recipients, the Australia and New Zealand Dialysis and Transplant Registry and the Collaborative Transplant Study were analyzed. We used multivariable Cox regression models to estimate the association between donor sex and death censored graft loss, accounting for the modifying effects of recipient sex and donor age; donor age was categorized as 5-19, 20-34, 35-49, 50-59 and ≥60 years. Results from cohort-specific Cox models were combined using individual patient data meta-analysis. RESULTS Among female recipients of donors aged <60 years, graft loss hazards did not differ by donor sex; recipients of female donors ≥60 years showed significantly lower graft loss hazards than recipients of male donors of the same age [combined adjusted hazard ratio (aHR) 0.90, 95% CI 0.86-0.94]. Among male recipients, female donors aged <50 years were associated with significantly higher graft loss hazards than same-aged male donors (5-19 years: aHR 1.11, 95% CI 1.02-1.21; 20-34 years: aHR 1.08, 95% CI 1.02-1.15; 35-49 years: aHR 1.07, 95% CI 1.04-1.10). There were no significant differences in graft loss by donor sex among male recipients of donors aged ≥50 years. CONCLUSION Donor age modifies the association between donor sex and graft survival. Older female donors were associated with similar or lower hazards of graft failure than older male donors in both male and female recipients, suggesting a better functional reserve of older female donor kidneys.
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Affiliation(s)
- Anette Melk
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | | | - Xun Zhang
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
| | - Mourad Dahhou
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Caner Süsal
- Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey
| | - Ruth Sapir-Pichhadze
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
- Department of Medicine, Division of Nephrology, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
- Department of Pediatrics, Division of Nephrology, McGill University, Montréal, QC, Canada
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Sibulesky L, Leca N, Bakthavatsalam R, Perkins JD. Kidney retransplantation outcomes in adults aged 70 and older: Analysis of risk factors and survival. Clin Transplant 2024; 38:e15170. [PMID: 37943592 DOI: 10.1111/ctr.15170] [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: 08/03/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND An increasing number of older patients are undergoing kidney transplant. Because of a finite longevity, more patients will be faced with failing allografts. At present there is a limited understanding of the benefits and risks associated with kidney retransplantation in this challenging population. METHODS We performed a retrospective analysis of the Organ Procurement and Transplantation Network database of all adults ≥70 undergoing kidney retransplant from January 1, 2014 to December 31, 2022. We examined patient and graft survival of retransplanted patients compared to first time transplants. We also analyzed the risk factors that impacted the survival. RESULTS During the study period there has been a significant rise in the number of retransplants performed, with 631 patients undergoing the procedure. Although clinically insignificant, overall graft, and patient survival rates were slightly lower in the retransplant group compared to the primary transplant group. With retransplant, patient survival was 91.3%, 75.6%, and 56.9% compared to 93.4%, 81.4%, and 64.4% with primary transplant at 1, 3, and 5 years, respectively. With retransplant, graft survival was 89.5%, 73.5%, 57.4% compared to 91.5%, 79.0%, and 63.6% in a primary transplant group at 1, 3, and 5 years, respectively. Multivariable analysis showed that factors predicting poor survival included longer time on dialysis before retransplantation and decreased functional capacity. No survival difference was noted between recipients of deceased versus living donor kidneys. Patients who underwent retransplantation before initiating dialysis had better patient and graft survival. CONCLUSION Patients aged ≥70 achieve satisfactory outcomes following kidney retransplantation, highlighting that chronologic age should not preclude this medically complex population from this life-saving procedure. Improvement in functional status and timely retransplantation are the key factors to successful outcome.
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Affiliation(s)
- Lena Sibulesky
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
- Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle, Washington, USA
| | - Nicolae Leca
- Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle, Washington, USA
- Division of Nephrology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Ramasamy Bakthavatsalam
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
| | - James D Perkins
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
- Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle, Washington, USA
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Noble J, Metzger A, Daligault M, Chevallier E, Bugnazet M, Bardy B, Naciri Bennani H, Terrier N, Fiard G, Franquet Q, Janbon B, Masson D, Giovannini D, Malvezzi P, Jouve T, Rostaing L. Immortal Time-Bias-Corrected Survival of Highly Sensitized Patients and HLA-desensitized Kidney Transplant Recipients. Kidney Int Rep 2021; 6:2629-2638. [PMID: 34622102 PMCID: PMC8484495 DOI: 10.1016/j.ekir.2021.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/22/2021] [Revised: 07/04/2021] [Accepted: 07/26/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction In the setting of kidney transplantation (KT), we assessed the efficacy of desensitization and compared the survival of desensitized patients (HLA-incompatible KT) with similarly sensitized patients receiving HLA-compatible KT or sensitized patients still on a waiting list after adjusting for the usually unaccounted immortal time bias. Methods All patients in a French KT center on the waiting list between August 1994 and December 2019 with a high level of sensitization (panel-reactive antibodies [PRAs] ≥80%) were included. The primary outcome was all-cause mortality. A time-varying covariate Cox survival model was used to account for the immortal time bias. A landmark analysis was used as a sensitivity analysis. Results During the study period, 326 patients with high PRAs were followed, among which 147 (45%) remained on the waiting list at the time of last follow-up and 179 benefited from a KT. Thirty-six patients were desensitized, of which 30 received a kidney transplant, including eight deceased kidney donors. There were no differences in mortality rates between desensitized KT patients, nondesensitized KT patients, and waitlisted patients after adjusting for immortal time bias (hazard ratio [HR] = 0.48, P = 0.22). Death-censored graft survival was similar between desensitized and nondesensitized KT patients (HR = 0.92, P = 0.88 adjusting for donor age >65 years, donor status, and time on the waiting list). Mean estimated glomerular filtration rate at 1 year post-KT was similar for desensitized KT patients (53.3 ± 21 vs. 53.6 ± 21 ml/min per 1.73 m2 for nondesensitized patients; P = 0.95). Conclusions HLA-desensitization was effective for highly sensitized patients and gave access to KT without detrimental effects on patient or graft survival rates.
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Affiliation(s)
- Johan Noble
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, Grenoble, France
- University Grenoble Alpes, Grenoble, France
| | - Antoine Metzger
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, Grenoble, France
| | - Melanie Daligault
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, Grenoble, France
| | - Eloi Chevallier
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, Grenoble, France
| | - Mathilde Bugnazet
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, Grenoble, France
| | - Beatrice Bardy
- HLA Laboratory - Établissement Français du Sang (EFS), Grenoble, France
| | - Hamza Naciri Bennani
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, Grenoble, France
| | - Nicolas Terrier
- Urology Department, University Hospital Grenoble, Grenoble, France
| | - Gaelle Fiard
- Urology Department, University Hospital Grenoble, Grenoble, France
| | - Quentin Franquet
- Urology Department, University Hospital Grenoble, Grenoble, France
| | - Benedicte Janbon
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, Grenoble, France
| | - Dominique Masson
- HLA Laboratory - Établissement Français du Sang (EFS), Grenoble, France
| | - Diane Giovannini
- Pathology Department, University Hospital Grenoble, Grenoble, France
| | - Paolo Malvezzi
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, Grenoble, France
| | - Thomas Jouve
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, Grenoble, France
- University Grenoble Alpes, Grenoble, France
| | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, Grenoble, France
- University Grenoble Alpes, Grenoble, France
- Correspondence: Lionel Rostaing, MD, PhD, Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Avenue Maquis du Grésivaudan, 38700 La Tronche, France.
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Bonthuis M, Cuperus L, Chesnaye NC, Akman S, Melgar AA, Baiko S, Bouts AH, Boyer O, Dimitrova K, Carmo CD, Grenda R, Heaf J, Jahnukainen T, Jankauskiene A, Kaltenegger L, Kostic M, Marks SD, Mitsioni A, Novljan G, Palsson R, Parvex P, Podracka L, Bjerre A, Seeman T, Slavicek J, Szabo T, Tönshoff B, Torres DD, Van Hoeck KJ, Ladfors SW, Harambat J, Groothoff JW, Jager KJ. Results in the ESPN/ERA-EDTA Registry suggest disparities in access to kidney transplantation but little variation in graft survival of children across Europe. Kidney Int 2020; 98:464-475. [PMID: 32709294 DOI: 10.1016/j.kint.2020.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 10/07/2019] [Revised: 02/27/2020] [Accepted: 03/16/2020] [Indexed: 01/10/2023]
Abstract
One of the main objectives of the European health policy framework is to ensure equitable access to high-quality health services across Europe. Here we examined country-specific kidney transplantation and graft failure rates in children and explore their country- and patient-level determinants. Patients under 20 years of age initiating kidney replacement therapy from January 2007 through December 2015 in 37 European countries participating in the ESPN/ERA-EDTA Registry were included in the analyses. Countries were categorized as low-, middle-, and high-income based on gross domestic product. At five years of follow-up, 4326 of 6909 children on kidney replacement therapy received their first kidney transplant. Overall median time from kidney replacement therapy start to first kidney transplantation was 1.4 (inter quartile range 0.3-4.3) years. The five-year kidney transplantation probability was 48.8% (95% confidence interval: 45.9-51.7%) in low-income, 76.3% (72.8-79.5%) in middle-income and 92.3% (91.0-93.4%) in high-income countries and was strongly associated with macro-economic factors. Gross domestic product alone explained 67% of the international variation in transplantation rates. Compared with high-income countries, kidney transplantation was 76% less likely to be performed in low-income and 58% less likely in middle-income countries. Overall five-year graft survival in Europe was 88% and showed little variation across countries. Thus, despite large disparities transplantation access across Europe, graft failure rates were relatively similar. Hence, graft survival in low-risk transplant recipients from lower-income countries seems as good as graft survival among all (low-, medium-, and high-risk) graft recipients from high-income countries.
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Affiliation(s)
- Marjolein Bonthuis
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Liz Cuperus
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Nicholas C Chesnaye
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Sema Akman
- Department of Pediatric Nephrology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Angel Alonso Melgar
- Department of Pediatric Nephrology, La Paz Children's Hospital, Madrid, Spain
| | - Sergey Baiko
- Department of Pediatrics, Belarusian State Medical University, Minsk, Belarus
| | - Antonia H Bouts
- Amsterdam UMC, University of Amsterdam, Department of Pediatric Nephrology, Emma Children's Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands
| | - Olivia Boyer
- Pediatric Nephrology Department, Université de Paris, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Kremena Dimitrova
- Nephrology and Hemodialysis Clinic, Department of Pediatrics, Medical University of Sofia, Sofia, Bulgaria
| | - Carmen do Carmo
- Department of Pediatric Nephrology, Hospital Pediátrico de Coimbra, Coimbra, Portugal
| | - Ryszard Grenda
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - James Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Lukas Kaltenegger
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Mirjana Kostic
- University Children's Hospital, Nephrology and Urology Departments, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andromachi Mitsioni
- Department of Nephrology, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Gregor Novljan
- Department of Pediatric Nephrology, University Medical Center Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Runolfur Palsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Paloma Parvex
- Department of Pediatrics, Division of Pediatric Nephrology, Geneva University Hospital, Geneva, Switzerland
| | - Ludmila Podracka
- Pediatric Department, Children's Hospital, Comenius University, Bratislava, Slovakia
| | - Anna Bjerre
- Divsion of Pedatrics and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Norway
| | - Tomas Seeman
- Department of Pediatrics and Biomedical Center, 2nd Faculty of Medicine and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Jasna Slavicek
- Division of Nephrology, Dialysis and Transplantation, Department of Pediatrics, University Hospital Zagreb, Zagreb, Croatia
| | - Tamas Szabo
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Diletta D Torres
- Pediatric Nephrology and Dialysis Unit, Pediatric Hospital "Giovanni XXIII," Bari, Italy
| | - Koen J Van Hoeck
- Department of Pediatric Nephrology, University Hospital Antwerp, Antwerp, Belgium
| | - Susanne Westphal Ladfors
- Department of Paediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jérôme Harambat
- Department of Pediatrics, Bordeaux University Hospital, Bordeaux Population Health Research Center UMR 1219, University of Bordeaux, Bordeaux, France
| | - Jaap W Groothoff
- Amsterdam UMC, University of Amsterdam, Department of Pediatric Nephrology, Emma Children's Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands
| | - Kitty J Jager
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
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Riad S, Goswami U, Jackson S, Hertz M, Matas A. Induction type and outcomes for kidney graft and patient survival in recipients with prior lung transplantation in the United States. J Heart Lung Transplant 2019; 39:157-164. [PMID: 31837899 DOI: 10.1016/j.healun.2019.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/29/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Induction immunosuppression regimens for kidney transplants in lung transplant recipients vary widely. We studied the impact of induction types for kidney after lung transplant recipients. METHODS Using the Scientific Registry of Transplant Recipients database between 1994 and 2015, we studied outcomes of patients and kidney grafts for 330 kidney after lung transplant recipients for whom induction before kidney transplant included depletional (n = 115), non-depletional (n = 170), or no induction (steroids only; n = 45). We studied risk factors for recipient and graft survival using Cox proportional hazards model adjusted for kidney and lung induction, kidney donor type, dialysis status, recipient and donor ages, time from lung to kidney transplant, cause of lung disease, bilateral vs single lung transplant, diabetes, and human leukocyte antigen mismatches before kidney transplant, with transplant center as a random effect. RESULTS There was no difference between groups in patient survival or death-censored kidney allograft survival. The 1-year kidney acute rejection rates were 15.5%, 7.14%, and 0% in depletional, non-depletional, and no induction groups, respectively. In the Cox model for patient survival, living kidney donor recipients and bilateral lung transplant recipients were favorable predictors. For death-censored graft survival, kidney induction type did not predict graft survival. Results did not change when models only included recipients on tacrolimus and mycophenolate based maintenance. CONCLUSIONS The type of kidney induction did not influence patient or kidney graft survival following kidney transplants for those with previous lung transplants. No induction may be the preferred choice for kidney after lung transplant because of the lack of benefits from biologic induction in this large cohort.
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Affiliation(s)
- Samy Riad
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - Umesh Goswami
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | | | - Marshall Hertz
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Arthur Matas
- Division of Transplant Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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Domagala P, Gorski L, Wszola M, Kieszek R, Diuwe P, Goralski P, Drozdowski J, Ostaszewska A, Gozdowska J, Ciszek M, Trzebicki J, Durlik M, Paczek L, Chmura A, Kwiatkowski A. Successful transplantation of kidneys from deceased donors with terminal acute kidney injury. Ren Fail 2019; 41:167-174. [PMID: 30909784 PMCID: PMC6442227 DOI: 10.1080/0886022x.2019.1590209] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There are many doubts with regards to accepting deceased kidneys with acute kidney injury (AKI) for transplantation. PURPOSE The aim of this study was to present the 5-years outcome of kidney transplantation cases where deceased donors developed AKI before organ procurement. METHODS Two hundred twenty-six deceased renal transplants were analyzed. Data regarding donors and recipients were collected. Terminal AKI was defined as terminal serum creatinine concentration higher than 1.99 mg/dL and 66 such cases were diagnosed. All kidney transplant recipients were followed for 60 months. RESULTS AKI group presented more episodes of delayed graft function (DGF) compared to the non-AKI group (56% vs 35%, p < .05). No differences were observed between the groups in the rate of acute rejection episodes, kidney function as well as patient and graft survival. CONCLUSIONS Transplants with AKI present more often DGF and comparable graft survival to transplants without AKI. Kidneys with AKI can be a valuable source of organs provided attentive selection and appropriate care of deceased donors.
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Affiliation(s)
- Piotr Domagala
- a Department of General and Transplantation Surgery , The Medical University of Warsaw , Warsaw , Poland
| | - Lukasz Gorski
- a Department of General and Transplantation Surgery , The Medical University of Warsaw , Warsaw , Poland
| | - Michal Wszola
- a Department of General and Transplantation Surgery , The Medical University of Warsaw , Warsaw , Poland
| | - Rafal Kieszek
- a Department of General and Transplantation Surgery , The Medical University of Warsaw , Warsaw , Poland
| | - Piotr Diuwe
- a Department of General and Transplantation Surgery , The Medical University of Warsaw , Warsaw , Poland
| | - Piotr Goralski
- a Department of General and Transplantation Surgery , The Medical University of Warsaw , Warsaw , Poland
| | - Jakub Drozdowski
- a Department of General and Transplantation Surgery , The Medical University of Warsaw , Warsaw , Poland
| | - Agata Ostaszewska
- a Department of General and Transplantation Surgery , The Medical University of Warsaw , Warsaw , Poland
| | - Jolanta Gozdowska
- b Department of Transplant Medicine, Nephrology and Internal Medicine , The Medical University of Warsaw , Warsaw , Poland
| | - Michal Ciszek
- c Department of Immunology, Transplantology and Internal Medicine , The Medical University of Warsaw , Warsaw , Poland
| | - Janusz Trzebicki
- d Department of Anaesthesiology and Intensive Care , The Medical University of Warsaw , Warsaw , Poland
| | - Magdalena Durlik
- b Department of Transplant Medicine, Nephrology and Internal Medicine , The Medical University of Warsaw , Warsaw , Poland
| | - Leszek Paczek
- c Department of Immunology, Transplantology and Internal Medicine , The Medical University of Warsaw , Warsaw , Poland
| | - Andrzej Chmura
- a Department of General and Transplantation Surgery , The Medical University of Warsaw , Warsaw , Poland
| | - Artur Kwiatkowski
- a Department of General and Transplantation Surgery , The Medical University of Warsaw , Warsaw , Poland
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Chan-On C, Sarwal MM. A Comprehensive Analysis of the Current Status and Unmet Needs in Kidney Transplantation in Southeast Asia. Front Med (Lausanne) 2017; 4:84. [PMID: 28691007 PMCID: PMC5481314 DOI: 10.3389/fmed.2017.00084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 02/25/2017] [Accepted: 06/06/2017] [Indexed: 01/24/2023] Open
Abstract
To address the unmet needs in the face of a growing demand for end-stage renal failure management and kidney transplantation in Asia, we have conducted a critical analysis of published literature and national registries to evaluate clinical outcomes and the rates of organ donation in Southeast Asia and the challenges facing these regions with regards to regulation, choice of donor source, and funding. Based on the available data, suggestions are proposed for an advancement of rates of organ donation and access, with emphasis on improved regulation and public education.
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Affiliation(s)
- Chitranon Chan-On
- Division of Nephrology, Faculty of Medicine, Department of Internal Medicine, Khon Kaen University, Khon Kaen, Thailand.,Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Minnie M Sarwal
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
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Rege A, Irish B, Castleberry A, Vikraman D, Sanoff S, Ravindra K, Collins B, Sudan D. Trends in Usage and Outcomes for Expanded Criteria Donor Kidney Transplantation in the United States Characterized by Kidney Donor Profile Index. Cureus 2016; 8:e887. [PMID: 28018757 PMCID: PMC5179248 DOI: 10.7759/cureus.887] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 01/30/2023] Open
Abstract
There has been increasing concern in the kidney transplant community about the declining use of expanded criteria donors (ECD) despite improvement in survival and quality of life. The recent introduction of the Kidney Donor Profile Index (KDPI), which provides a more granular characterization of donor quality, was expected to increase utilization of marginal kidneys and decrease the discard rates. However, trends and practice patterns of ECD kidney utilization on a national level based on donor organ quality as per KDPI are not well known. We, therefore, performed a trend analysis of all ECD recipients in the United Network for Organ Sharing (UNOS) registry between 2002 and 2012, after calculating the corresponding KDPI, to enable understanding the trends of usage and outcomes based on the KDPI characterization. High-risk recipient characteristics (diabetes, body mass index ≥30 kg/m2, hypertension, and age ≥60 years) increased over the period of the study (trend test p<0.001 for all). The proportion of ECD transplants increased from 18% in 2003 to a peak of 20.4% in 2008 and then declined thereafter to 17.3% in 2012. Using the KDPI >85% definition, the proportion increased from 9.4% in 2003 to a peak of 12.1% in 2008 and declined to 9.7% in 2012. Overall, although this represents a significant utilization of kidneys with KDPI >85% over time (p<0.001), recent years have seen a decline in usage, probably related to regulations imposed by Centers for Medicare & Medicaid Services (CMS). When comparing the hazards of graft failure by KDPI, ECD kidneys with KDPI >85% have a slightly lower risk of graft failure compared to standard criteria donor (SCD) kidneys with KDPI >85%, with a hazard ratio (HR) of 0.95, a confidence interval (CI) of 0.94-0.96, and statistical significance of p<0.001. This indicates that some SCD kidneys may actually have a lower estimated quality, with a higher Kidney Donor Risk Index (KDRI), than some ECDs. The incidence of delayed graft function (DGF) in ECD recipients has significantly decreased over time from 35.2% in 2003 to 29.6% in 2011 (p=0.007), probably related to better understanding of the donor risk profile along with increased use of hypothermic machine perfusion and pretransplant biopsy to aid in optimal allograft selection. The recent decline in transplantation of KDPI >85% kidneys probably reflects risk-averse transplant center behavior. Whether discard of discordant SCD kidneys with KDPI >85% has contributed to this decline remains to be studied.
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Affiliation(s)
| | - Bill Irish
- Health Outcomes Research & Biostatistics, CTI Clinical Trial and Consulting
| | | | - Deepak Vikraman
- Surgery, Duke University Medical Center ; Division of Abdominal Transplantation, Duke University Medical Center
| | - Scott Sanoff
- Transplant Nephrology, Duke University Medical Center
| | - Kadiyala Ravindra
- Surgery, Duke University Medical Center ; Division of Abdominal Transplantation, Duke University Medical Center
| | | | - Debra Sudan
- Surgery, Duke University Medical Center ; Division of Abdominal Transplantation, Duke University Medical Center
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Nakada Y, Yamamoto I, Horita S, Kobayashi A, Mafune A, Katsumata H, Yamakawa T, Katsuma A, Kawabe M, Tanno Y, Ohkido I, Tsuboi N, Yamamoto H, Okumi M, Ishida H, Yokoo T, Tanabe K. The prognostic values of caveolin-1 immunoreactivity in peritubular capillaries in patients with kidney transplantation. Clin Transplant 2016; 30:1417-1424. [PMID: 27543925 DOI: 10.1111/ctr.12833] [Citation(s) in RCA: 8] [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] [Accepted: 08/15/2016] [Indexed: 12/24/2022]
Abstract
The low sensitivity of C4d immunoreactivity in peritubular capillaries (PTCs) hinders its use in the diagnosis of chronic active antibody-mediated rejection (CAAMR). C4d-negative CAAMR was defined in the 2013 Banff classification, which included the expression of endothelial-associated transcripts (ENDATs). We previously showed that the ENDAT caveolin-1 (CAV-1) is a distinct feature of CAAMR. In this study, we investigated the prognostic value of CAV-1 immunoreactivity in PTCs in kidney transplant patients. Ninety-eight kidney transplant recipients were included in this study. The prognostic value of CAV-1 immunoreactivity in PTCs was evaluated by double immunostaining for CAV-1 and pathologische Anatomie Leiden endothelium (PAL-E, a PTC marker) in the PTCs of kidney allograft biopsy samples. The patients were divided into two groups: CAV-1/PAL-E<50% and CAV-1/PAL-E≥50%. Kaplan-Meier curves showed that CAV-1/PAL-E≥50% patients had a significantly worse prognosis than that of CAV-1/PAL-E<50% patients (log-rank; P<.001). C4d staining of PTCs was not associated with the development of graft failure (log-rank; P=.345), whereas in a multivariate Cox regression analysis, CAV-1 immunoreactivity in PTCs was independently associated with graft failure (hazard ratio: 11.1; P=.0324). CAV-1 immunoreactivity in PTCs may serve as a prognostic marker for kidney allograft survival.
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Affiliation(s)
- Yasuyuki Nakada
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Izumi Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Shigeru Horita
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Akimitsu Kobayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Aki Mafune
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruki Katsumata
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yamakawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Ai Katsuma
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Mayuko Kawabe
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yudo Tanno
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyasu Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Internal Medicine, Atsugi City Hospital, Kanagawa, Japan
| | - Masayoshi Okumi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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10
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Heaphy ELG, Poggio ED, Flechner SM, Goldfarb DA, Askar M, Fatica R, Srinivas TR, Schold JD. Risk factors for retransplant kidney recipients: relisting and outcomes from patients' primary transplant. Am J Transplant 2014; 14:1356-67. [PMID: 24731101 DOI: 10.1111/ajt.12690] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 01/14/2014] [Accepted: 02/02/2014] [Indexed: 01/25/2023]
Abstract
As of November 2013, 14.5% of the waitlist for a donor kidney comprised patients awaiting a retransplant. We performed a retrospective cohort study of 11,698 adult solitary kidney recipients using national Scientific Registry of Transplant Recipients data transplanted between 2002 and 2011. The aim was to investigate whether outcomes from patients' initial transplants are significant risk factors for patients' repeat transplants or for likelihood of relisting after a failed primary transplant. Retransplant recipients were more likely to be treated for acute rejection [adjusted odds ratio (AOR), 95% confidence interval (CI) = 1.26 (1.07-1.48), p = 0.0053] or hospitalized (AOR = 1.19, 95% CI 1.08-1.31, p = 0.0005) within a year of retransplantation if these outcomes were experienced within a year of primary transplant. Delayed graft function following primary transplants was associated with 35% increased likelihood of recurrence (AOR = 1.35, 95% CI = 1.18-1.54, p < 0.0001). An increase in 1-year GFR after primary transplant was associated with GFR 1 year postretransplant (β = 6.82, p < 0.0001), and retransplant graft failure was inversely associated with 1-year primary transplant GFR (adjusted hazard ratio = 0.74, 95% CI = 0.71-0.76 per 10 mL/min/1.73 m(2) ). A decreased likelihood for relisting was associated with hospitalization and higher GFR following primary transplantation. The increasing numbers of individuals requiring retransplants highlights the importance of incorporating prior transplant outcomes data to better inform relisting decisions and prognosticating retransplant outcomes.
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Affiliation(s)
- E L G Heaphy
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
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Lee B, Kumar V, Williams T, Abdi R, Bernhardy A, Dyer C, Conte S, Genovese G, Ross M, Friedman D, Gaston R, Milford E, Pollak M, Chandraker A. The APOL1 genotype of African American kidney transplant recipients does not impact 5-year allograft survival. Am J Transplant 2012; 12:1924-8. [PMID: 22487534 PMCID: PMC3387301 DOI: 10.1111/j.1600-6143.2012.04033.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [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
Apolipoprotein L-1 (APOL1) gene variants are associated with end-stage renal disease in African Americans (AAs). Here we investigate the impact of recipient APOL1 gene distributions on kidney allograft outcomes. We conducted a retrospective analysis of 119 AA kidney transplant recipients, and found that 58 (48.7%) carried two APOL1 kidney disease risk variants. Contrary to the association seen in native kidney disease, there is no difference in allograft survival at 5-year posttransplant for recipients with high-risk APOL1 genotypes. Thus, we were able to conclude that APOL1 genotypes do not increase risk of allograft loss after kidney transplantations, and carrying 2 APOL1 risk alleles should not be an impediment to transplantation.
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Affiliation(s)
- B.T. Lee
- Division of Nephrology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - V. Kumar
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - T.A. Williams
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - R. Abdi
- Division of Nephrology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - A. Bernhardy
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - C. Dyer
- Division of Nephrology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - S. Conte
- Division of Nephrology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - G. Genovese
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - M.D. Ross
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - D.J. Friedman
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - R. Gaston
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - E. Milford
- Division of Nephrology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - M.R. Pollak
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - A. Chandraker
- Division of Nephrology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, Correspondence: Anil Chandraker, MD. 75 Francis Street, MRB 4 Floor, Renal Division. Boston, MA 02115. Phone 617-732-7412. Fax 617-264-5108.
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Woodward RS, Page TF, Soares R, Schnitzler MA, Lentine KL, Brennan DC. Income-related disparities in kidney transplant graft failures are eliminated by Medicare's immunosuppression coverage. Am J Transplant 2008; 8:2636-46. [PMID: 19032227 PMCID: PMC3189683 DOI: 10.1111/j.1600-6143.2008.02422.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [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
Beginning January 1, 2000, Medicare extended coverage of immunosuppression medications from 3 years to lifetime based on age >65 years or disability. Using United States Renal Data System (USRDS) data for Medicare-insured recipients of kidney transplants between July 1995 and December 2000, we identified four cohorts of Medicare-insured kidney transplant recipients. Patients in cohort 1 were individuals who were both eligible and received lifetime coverage. Patients in cohort 2 would have been eligible, but their 3-year coverage expired before lifetime coverage was available. Patients in cohort 3 were ineligible for lifetime coverage because of youth or lack of disability. Patients in cohort 4 were transplanted between 1995 and 1996 and were ineligible for lifetime coverage. Incomes were categorized by ZIP code median household income from census data. Lifetime extension of Medicare immunosuppression was associated with improved allograft survival among low-income transplant recipients in the sense that the previously existing income-related disparities in graft survival in cohort 2 were not apparent in cohort 1. Ineligible individuals served as a control group; the income-related disparities in graft survival observed in the early cohort 4 persisted in more recent cohort 3. Multivariate proportional hazards models confirmed these findings. Future work should evaluate the cost effectiveness of these coverage increases, as well as that of benefits extensions to broader patient groups.
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Affiliation(s)
- Robert S. Woodward
- Departments of Health Management and Policy and Economics, University of New Hampshire, Durham, NH
| | - Timothy F. Page
- Departments of Health Management and Policy and Economics, University of New Hampshire, Durham, NH
| | - Ricardo Soares
- Department of Economics, Federal University of Ceara, Fortaleza-CE, Brazil
| | - Mark A. Schnitzler
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Krista L. Lentine
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Daniel C. Brennan
- Division of Nephrology, Washington University School of Medicine, St. Louis, MO
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