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Journal articles on the topic 'Kidney transplant'
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1
Husain, Syed Ali, Mariana C. Chiles, Samnang Lee, Stephen O. Pastan, Rachel E. Patzer, Bekir Tanriover, Lloyd E. Ratner, and Sumit Mohan. "Characteristics and Performance of Unilateral Kidney Transplants from Deceased Donors." Clinical Journal of the American Society of Nephrology 13, no. 1 (December 7, 2017): 118–27. http://dx.doi.org/10.2215/cjn.06550617.
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Background and objectivesThe fraction of kidneys procured for transplant that are discarded is rising in the United States. Identifying donors from whom only one kidney was discarded allows us to control for donor traits and better assess reasons for organ discard.Design, setting, participants, & measurementsWe conducted a retrospective cohort study using United Network for Organ Sharing Standard Transplant Analysis and Research file data to identify deceased donors from whom two kidneys were procured and at least one was transplanted. Unilateral pairs were defined as kidney pairs from a single donor from whom one kidney was discarded (“unilateral discard”) but the other was transplanted (“unilateral transplant”). Organ quality was estimated using the Kidney Donor Risk Index and Kidney Donor Profile Index (KDPI). We compared all-cause graft failure rates for unilateral transplants to those for bilateral transplant Kaplan–Meier methods, and life table methodology was used to evaluate 1-, 2-, 3-, and 5-year survival rates of transplants from bilateral and unilateral donors.ResultsCompared with bilateral donors (i.e., both kidneys transplanted) (n=80,584), unilateral donors (i.e., only one kidney transplanted) (n=7625) had higher mean terminal creatinine (1.3±2.1 mg/dl versus 1.1±0.9 mg/dl) and KDPI (67%±25% versus 42%±27%), were older, and were more likely to have hypertension, diabetes, hepatitis C, terminal stroke, or meet Centers for Disease Control and Prevention high-risk donor criteria. Unilateral discards were primarily attributed to factors expected to be similar in both kidneys from a donor: biopsy findings (22%), no interested recipient (13%), and donor history (7%). Anatomic abnormalities (14%), organ damage (11%), and extended ischemia (6%) accounted for about 30% of discards, but were the commonest reasons among low KDPI kidneys. Among kidneys with KDPI≥60%, there was an incremental difference in allograft survival over time (for unilateral versus bilateral transplants, 1-year survival: 83% versus 87%; 3-year survival: 69% versus 73%; 5-year survival: 51% versus 58%).ConclusionsA large number of discarded kidneys were procured from donors whose contralateral kidneys were transplanted with good post-transplant outcomes.
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Patrick, Grant, Brian Hickner, Karthik Goli, Liam D. Ferreira, John Goss, and Abbas Rana. "Trends in Survival for Adult Organ Transplantation." Annals of Surgery Open 5, no. 1 (February 22, 2024): e383. http://dx.doi.org/10.1097/as9.0000000000000383.
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Objective: Intent-to-treat analysis follows patients from listing to death, regardless of their transplant status, and aims to provide a more holistic scope of the progress made in adult solid-organ transplantation. Background: Many studies have shown progress in waitlist and post-transplant survival for adult kidney, liver, heart, and lung transplants, but there is a need to provide a more comprehensive perspective of transplant outcomes for patients and their families. Methods: Univariable and multivariable Cox regression analyses were used to analyze factors contributing to intent-to-treat survival in 813,862 adults listed for kidney, liver, heart, and lung transplants. The Kaplan–Meier method was used to examine changes in waitlist, post-transplant, and intent-to-treat survival. Transplantation rates were compared using χ2 tests. Results: Intent-to-treat survival has steadily increased for liver, heart, and lung transplants. The percentage of patients transplanted within 1 year significantly increased for heart (57.4% from 52.9%) and lung (73.5% from 33.2%). However, the percentage of patients transplanted within 1 year significantly decreased from 35.8% to 21.2% for kidney transplant. Notably, intent-to-treat survival has decreased for kidneys despite increases in waitlist and post-transplant survival, likely because of the decreased transplant rate. Conclusion: Intent-to-treat survival steadily improved for liver, heart, and lung transplant over the 30-year study period. Continued advancements in allocation policy, immunosuppression, and improved care of patients on the waitlist may contribute to further progress in outcomes of all organs, but the increasing discrepancy in supply and demand of donor kidneys is alarming and has impeded the progress of kidney intent-to-treat survival.
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Nghiem, Dai D. "The Deceased Transplant Recipients: A Forgotten Source of Organ Donors." Uro 3, no. 3 (July 3, 2023): 187–98. http://dx.doi.org/10.3390/uro3030020.
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Background: Organ transplantation is the most successful therapy for end-stage organ disease since it increases the quality of life and life expectancy. For these reasons, over 107,000 patients were on the waitlist in the United States for a transplant in 2022. Unfortunately, only 42,887 transplants were performed, and annually, over 7000 patients on the kidney list die or are too sick to transplant. To solve this severe organ shortage, the use of the deceased transplant recipients with functioning organs, whether transplanted or native, is explored as a new source of organ donors. Methods: To assess the feasibility of this option, first, we will review the rate of kidney transplant recipients dying with functioning grafts (DWGF), their re-use, the organ allocation system, the technical aspects of the organ procurement, and the transplantation of the DWGF kidneys. Then, we will consider the larger group of all deceased transplant recipients as potential donors for all functioning, native, or transplanted organs. Conclusions: (1). All functioning kidney transplants explanted from the deceased transplant recipients have excellent long-term function after re-transplantation. (2). The other functioning organs constitute a large unrecognized pool of transplantable organs. (3). The intensivists and the transplant community should be educated about these new options to improve the organ shortage.
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Ibrahim, Maria, George H. B. Greenhall, Dominic M. Summers, Lisa Mumford, Rachel Johnson, Richard J. Baker, John Forsythe, Gavin J. Pettigrew, Niaz Ahmad, and Chris J. Callaghan. "Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom." Clinical Journal of the American Society of Nephrology 15, no. 9 (July 20, 2020): 1320–29. http://dx.doi.org/10.2215/cjn.02060220.
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Background and objectivesKidneys 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, & measurementsData 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.ResultsDuring 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).ConclusionsRecipients 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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Halperin, Rabbi Mordechai. "Organ Transplants from Living Donors." Israel Law Review 27, no. 4 (1993): 566–87. http://dx.doi.org/10.1017/s002122370001150x.
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I. Survey of Transplant TechniquesThe kidney is one of the few organs which today can be successfully transplanted from a living donor to an ailing recipient. A healthy donor can function satisfactorily with a single kidney; therefore the removal of one kidney for transplantation does not significantly endanger the donor's life. However, removal, or even partial removal, of other organs, such as the heart, lungs, or pancreas, will present a serious risk to the health and life of the donor.In addition to organs, skin, bone marrow, blood and other body parts can be transplanted from living donors.A. Kidney TransplantsThe kidneys function to regulate the body's electrolyte and water balance and eliminate various wastes. Severe kidney dysfunction endangers the patient's life, and requires treatment by dialysis or kidney transplant. Up until a decade ago, the life expectancy of patients treated by dialysis exceeded that of patients who underwent kidney transplants. Over the past decade, the life expectancy of patients who have undergone kidney transplants from deceased donors has increased to a point where it is now comparable with the life expectancy of patients on dialysis.
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Churchill, P. C., M. C. Churchill, and A. K. Bidani. "Kidney cross transplants in Dahl salt-sensitive and salt-resistant rats." American Journal of Physiology-Heart and Circulatory Physiology 262, no. 6 (June 1, 1992): H1809—H1817. http://dx.doi.org/10.1152/ajpheart.1992.262.6.h1809.
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Previous kidney cross-transplant studies have demonstrated that the genotype of the kidney plays a role in determining the blood pressure of the recipient in Dahl salt-sensitive (S) and salt-resistant (R) rats. The present studies were designed to elucidate this role. Kidney cross transplants were performed in unilaterally nephrectomized male recipients (John Rapp strains), such that each rat had a native kidney and a transplanted kidney of the opposite genotype. S and R rats with a native kidney and a transplanted kidney of the same genotype served as controls. After 4 wk on a 7.8% NaCl diet, rats were anesthetized and renal clearance studies were performed. S kidneys had lower glomerular filtration rate (GFR) and renal plasma flow (RPF) than R kidneys, and these differences were determined by the kidney's genotype rather than the recipient's, since S kidneys in R recipients tended to have lower GFR and RPF than R kidneys in S recipients. In contrast, independent of the kidney's genotype, the kidneys in S rats tended to have higher fractional excretion of H2O and Na (FEH2O and FENa) than the kidneys in R rats. Thus there were genetically determined differences in renal function between S and R rats; some (RPF and GFR) were intrinsic to the kidney, whereas others (FEH2O and FENa) were intrinsic to the host.(ABSTRACT TRUNCATED AT 250 WORDS)
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Salmanipour, Alireza, Mostafa Ghadamzadeh, Seyed Morteza Bagheri, Roja Hajipour, Pedram Sadeghi, and Farzan Vahedifard. "Comparison the Diagnostic Value of Doppler Ultrasonography to Biopsy, in Evaluation of Post-transplant Complications and Kidney Function." Journal of Organ Transplantation 1, no. 2 (October 13, 2022): 21–27. http://dx.doi.org/10.14302/issn.2576-9359.jot-22-4303.
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Background Doppler ultrasonography can evaluate vascular and renal parenchymal disorders. In this study, color Doppler patterns in transplanted kidneys were compared with histological diagnosis to develop diagnostic models for transplanted kidney failure. Method 45 kidney transplant patients participated in this prospective study (16 suffered acute tubular necrosis (ATN), and 29 had transplant rejection). All patients had color-Doppler ultrasonography to measure kidney parameters and Doppler indices. Serum creatinine levels also assessed the transplanted kidney's function. Result Ultrasound showed a significant difference between the two groups in iliac and interlobar PSV. The ROC analysis showed a high diagnostic value of the iliac artery PSV, in distinguishing ATN from kidney transplant rejection. Serum creatinine level correlated directly with transplanted kidney volume, renal cortical thickness, and transplanted kidney length, and inversely with interlobar artery PSV and EDV. In graft rejection patients, the only significant inverse correlation was found between serum creatinine level and PSV of the iliac artery and EDV of the intrelobar artery. Discussion and conclusion The iliac artery PSV can differentiate between ATN and rejection after renal transplantation. Evaluation of renal metric parameters along with PSV and EDV of the interlobar artery (in patients with ATN) and iliac artery and interlobar artery (in transplant rejection) help determine renal dysfunction.
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Parajuli, Sandesh, Jacqueline Garonzik-Wang, Brad C. Astor, Fahad Aziz, Neetika Garg, Bridget Welch, Jon Odorico, et al. "Twelve Thousand Kidney Transplants Over More Than 55 Y: A Single-center Experience." Transplantation Direct 10, no. 2 (January 19, 2024): e1575. http://dx.doi.org/10.1097/txd.0000000000001575.
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Background. Kidney transplant outcomes have dramatically improved since the first successful transplant in 1954. In its early years, kidney transplantation was viewed more skeptically. Today it is considered the treatment of choice among patients with end-stage kidney disease. Methods. Our program performed its first kidney transplant in 1966 and recently performed our 12 000th kidney transplant. Here, we review and describe our experience with these 12 000 transplants. Transplant recipients were analyzed by decade of date of transplant: 1966–1975, 1976–1985, 1986–1995, 1996–2005, 2006–2015, and 2016–2022. Death-censored graft failure and mortality were outcomes of interest. Results. Of 12 000 kidneys, 247 were transplanted from 1966 to 1975, 1147 from 1976 to 1985, 2194 from 1986 to 1995, 3147 from 1996 to 2005, 3046 from 2006 to 2015, and 2219 from 2016 to 2022 compared with 1966–1975, there were statistically significant and progressively lower risks of death-censored graft failure at 1 y, 5 y, and at last follow-up in all subsequent eras. Although mortality at 1 y was lower in all subsequent eras after 1986–1995, there was no difference in mortality at 5 y or the last follow-up between eras. Conclusions. In this large cohort of 12 000 kidneys from a single center, we observed significant improvement in outcomes over time. Kidney transplantation remains a robust and ever-growing and improving field.
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Goesch, Torsten R., Nancy A. Wilson, Weifeng Zeng, Bret M. Verhoven, Weixiong Zhong, Maya M. Coumbe Gitter, and William E. Fahl. "Suppression of Inflammation-Associated Kidney Damage Post-Transplant Using the New PrC-210 Free Radical Scavenger in Rats." Biomolecules 11, no. 7 (July 19, 2021): 1054. http://dx.doi.org/10.3390/biom11071054.
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Allograft kidney transplantation, which triggers host cellular- and antibody-mediated rejection of the kidney, is a major contributor to kidney damage during transplant. Here, we asked whether PrC-210 would suppress damage seen in allograft kidney transplant. Brown Norway (BN) rat kidneys were perfused in situ (UW Solution) with or without added 30 mM PrC-210, and then immediately transplanted into Lewis (LEW) rats. 20 h later, the transplanted BN kidneys and LEW rat plasma were analyzed. Kidney histology, and kidney/serum levels of several inflammation-associated cytokines, were measured to assess mismatch-related kidney pathology, and PrC-210 protective efficacy. Twenty hours after the allograft transplants: (i) significant histologic kidney tubule damage and mononuclear inflammatory cell infiltration were seen in allograft kidneys; (ii) kidney function metrics (creatinine and BUN) were significantly elevated; (iii) significant changes in key cytokines, i.e., TIMP-1, TNF-alpha and MIP-3A/CCL20, and kidney activated caspase levels were seen. In PrC-210-treated kidneys and recipient rats, (i) kidney histologic damage (Banff Scores) and mononuclear infiltration were reduced to untreated background levels; (ii) creatinine and BUN were significantly reduced; and (iii) activated caspase and cytokine changes were significantly reduced, some to background. In conclusion, the results suggest that PrC-210 could provide broadly applicable organ protection for many allograft transplantation conditions; it could protect transplanted kidneys during and after all stages of the transplantation process—from organ donation, through transportation, re-implantation and the post-operative inflammation—to minimize acute and chronic rejection.
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Gruessner, Rainer W. G., Arthur J. Matas, Goncal Lloveras, David S. Fryd, David L. Dunn, William D. Payne, David E. R. Sutherland, and John S. Najarian. "A comparison of single and double pediatric cadaver donor kidneys for transplantation." Clinical Transplantation 3, no. 4 (August 1989): 209–14. http://dx.doi.org/10.1111/j.1399-0012.1989.tb00184.x.
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Use of pediatric cadaver kidneys for transplantation is controversial; reports of outcome following pediatric donor transplantation have shown either similar results or worse results than when adult donors are used. Two techniques have been proposed for use of pediatric donor kidneys ‐ transplantation of a single kidney, or transplantation of both kidneys with a common aorta and cava to a single recipient. Single kidney transplants make optimum use of the donor pool; double transplants provide increased renal mass and therefore more functional reserve in the early posttransplant period. No study from a single institution has compared outcome after double versus single pediatric cadaver kidney transplantation. To investigate this issue, we reviewed our experience with 131 pediatric cadaver kidneys (donor age ≤ 10 years) transplanted between 1971 and 1988. We compared outcome of these transplants to outcome of adult donor kidney transplants. Of the group receiving pediatric kidneys, 33 (25%) received double and 98 (75%) received single pediatric kidney transplants. For double pediatric graft recipients, 5 and 10‐yr patient survival rates were 81% and 75%, respectively, whereas for single graft recipients, 5‐ and 10‐yr patient survival rates were 67% and 54% (NS). Graft survival was 78% (1 yr) and 48% (10 yr) in double kidney transplant recipients, but only 61% (1 yr) and 34% (10 yr) in single kidney transplant recipients (p = 0.07). When compared to adult cadaver kidney recipients, double graft recipients had similar short‐ and long‐term outcome (p = 0.6), whereas single pediatric kidney recipients had significantly decreased graft survival (p = 0.03). Pathogenesis for graft loss was similar in double and single pediatric kidney transplants. However, early graft loss (within first 3 months posttransplant) due to rejection was more frequent in single (16%) than in double (3%) pediatric allograft recipients (NS). We conclude that double pediatric cadaver kidneys provide an overall higher patient and graft survival. However, optimal use of the donor pool may be made by the use of single pediatric kidney transplants.
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Minina, M. G., N. A. Ignatov, and S. B. Truhmanov. "Mathematical аnalysis of kidney transplant demand and availability." Russian Journal of Transplantology and Artificial Organs 19, no. 4 (January 30, 2018): 27–33. http://dx.doi.org/10.15825/1995-1191-2017-4-27-33.
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Aim. To analyse the dynamics of the need and availability of donor kidneys for transplantation. To construct the predictions for the number of waiting lists. To analyse the annual number of kidney transplants and the availability ofdonor kidney.Materials and methods. Data base of Eurotransplant International Foundation 1969–2015 has been analyzed. We built a forecast of the kidney waiting list, kidney transplants quantity and availability of kidney grafts up to 2030.Results. Random process analysis of kidney transplant recipients number has shown an increasing linear trend. Growing linear trend is due to the inability to fully meet the increasing need for a kidney transplant. Presence of a regular stochastic component is revealed that provides random fl uctuations in the number of patients waiting for kidney transplantation with a period of 35–40 years. Random process of the number of kidney transplants showed an exponential asymptotic trend growing to a certain saturation value. Estimation of its autocorrelation function showed the absence of regular stochastic components in it. Preservation of 1969–2015 dynamics for the period 2015–2030 allows to suggest a signifi cant increase in the number of people waiting for transplant and a decrease in the availability of donor kidneys.Conclusion. The number of donor kidney transplantations tends to saturation limit, and limit is already lower than the current need for donor kidneys. The increase in the number of kidney transplantation programs and the improvement of organ donation system may lead to a limited increase in annual number of transplants and, possibly, the saturation limit, but not to a qualitative change in the dynamics of reduced availability of donor kidneys. A qualitative change in this dynamics towards increasing accessibility, is possible perhaps through activities that affect factors causing a constant increase in the number of people who need a transplant.
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Bhattacharyya, Aniruddha, Lee R. Friedman, Beje S. Thomas, and Coleman I. Smith. "Economic Considerations in Using HCV and HIV Positive Donors for Kidney Transplant." OBM Transplantation 05, no. 04 (August 29, 2021): 1. http://dx.doi.org/10.21926/obm.transplant.2104154.
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End Stage Renal Disease is becoming more prevalent in the United States of America, with demand for kidney transplant exceeding the available organ supply. A novel method to increase the donor pool has been to consider transplanting organs from deceased patients who have had Hepatitis C Virus (HCV) or Human Immunodeficiency Virus (HIV) infections. Transplants with HCV infected kidneys are becoming more prevalent, due to increased organ supply due to increased mortality from injection opioid use. Similarly, deceased donor transplants using kidneys infected with HIV have become more common following the passage of the “HIV Organ Policy Equity (HOPE) Act” in 2013. These novel transplant strategies present distinct socioeconomic impacts which differ from those of prior transplant practices. Here, we have reviewed the costs and benefits of receiving a kidney transplant from deceased donors infected with HIV or HCV, compared to receiving a non-viremic kidney transplant.
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Ayorinde, John OO, Dominic M. Summers, Laura Pankhurst, Emma Laing, Alison J. Deary, Karla Hemming, Edward CF Wilson, Victoria Bardsley, Desley A. Neil, and Gavin J. Pettigrew. "PreImplantation Trial of Histopathology In renal Allografts (PITHIA): a stepped-wedge cluster randomised controlled trial protocol." BMJ Open 9, no. 1 (January 2019): e026166. http://dx.doi.org/10.1136/bmjopen-2018-026166.
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IntroductionMost potential kidney transplant donors in the UK are aged over 60 years, yet increasing donor age is associated with poorer graft survival and function. Urgent preimplantation kidney biopsy can identify chronic injury, and may aid selection of better ‘quality’ kidneys from this group. However, the impact of biopsy on transplant numbers remains unproven. The PreImplantation Trial of Histopathology In renal Allografts (PITHIA) study will assess whether the introduction of a national, 24 hours, digital histopathology service increases the number, and improves outcomes, of kidneys transplanted in the UK from older deceased donors.Methods and analysisPITHIA is an open, multicentre, stepped-wedge cluster randomised study, involving all UK adult kidney transplant centres. At 4-monthly intervals, a group of 4–5 randomly selected clusters (transplant centres) will be given access to remote, urgent, digital histopathology (total intervention period, 24 months). The trial has two primary end points: it is powered for an 11% increase in the proportion of primary kidney offers from deceased donors aged over 60 years that are transplanted, and a 6 mL/min increase in the estimated glomerular filtration rate of recipients at 12 months post-transplant. This would equate to an additional 120 kidney transplants performed in the UK annually. Trial outcome data will be collected centrally via the UK Transplant Registry held by NHS Blood and Transplant (NHSBT) and will be analysed using mixed effects models allowing for clustering within centres and adjusting for secular trends. An accompanying economic evaluation will estimate the cost-effectiveness of the service to the National Health Service.Ethics and disseminationThe study has been given favourable ethical opinion by the Cambridge South Research Ethics Committee and is approved by the Health Research Authority. We will present our findings at key transplant meetings, publish results within 4 years of the trial commencing and support volunteers at renal patient groups to disseminate the trial outcome.Trial registrationnumberISRCTN11708741; Pre-results.
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Terasaki, Paul I., David W. Gjertson, J. Michael Cecka, Steve Takemoto, and Yong Won Cho. "Significance of the donor age effect on kidney transplants." Clinical Transplantation 11, no. 5pt1 (October 1997): 366–72. http://dx.doi.org/10.1111/j.1399-0012.1997.tb00836.x.
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AbstractThe shortage of cadaveric donor kidneys for transplantation has forced a re‐evaluation of the limits on donor age acceptability. However, as more kidneys from older donors have been transplanted, a significantly lower graft survival has been noted among their recipients. The impact of utilizing older donor kidneys and the relative importance of donor age with respect to other factors has not been clarified. A total of 43 172 cadaver donor transplants reported to the UNOS Scientific Renal Transplant Registry between 1987 and 1995 were the subjects of this study. Cox regression analysis was utilized to assess the joint effects on graft survival of donor age and HLA mismatch, recipient sex, race, age, original disease, donor death cause, cold ischemia time, and transplant year. Increased first day anuria, dialysis requirement, and discharge serum creatinine were noted with increasing donor age. Moreover, long‐term graft and patient survival diminished as donor age increased. The 5‐yr graft survival of zero HLAA,B,DR mismatched kidneys fell steadily from 81% when the donor was aged 21‐30 to 39% when the donor was over age 60. The reported causes of kidney transplant failure were remarkably similar for old and young donors. The best transplant results were obtained with zero HLA‐A,B,DR mismatched transplants from young donors and the worst with older donor kidneys, regardless of HLA compatibility. We calculated that up to 21% of kidney failures resulted from insufficient renal mass due to age and were incorrectly attributed to chronic rejection.
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Altshuler, Peter J., Adam S. Bodzin, Kenneth A. Andreoni, Pooja Singh, Anju Yadav, Jaime M. Glorioso, Ashesh P. Shah, Carlo Gerado B. Ramirez, Warren R. Maley, and Adam M. Frank. "Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States." Transplantation Direct 11, no. 1 (December 18, 2024): e1744. https://doi.org/10.1097/txd.0000000000001744.
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Background. Deceased donor multiorgan transplants utilizing kidneys (MOTs) can improve outcomes for multiorgan recipients but reduces kidneys for chronic renal failure patients. Methods. We reviewed the Organ Procurement and Transplantation Network database from 2015 through 2019, for adult deceased donor kidney transplants. Recipients were classified as kidney transplant alone (KTA) (n = 62,252) or MOTs pancreas-kidney, simultaneous pancreas-kidney (n = 3,976), liver-kidney, simultaneous liver-kidney (n = 3,212), heart-kidney, simultaneous heart-kidney (n = 808), and “other”-kidney, simultaneous “other” kidney (n = 73). Results. Liver, heart, and lung-alone transplants were at least 7 times more frequent than their MOT correlate, whereas the inverse was true with pancreas transplantation with SPKs being by far the most common pancreas transplant type. On average, KTA recipients waited between 2.8 and 21.4 times longer than MOTs, with SPKs waiting the longest of the MOT types. Predialysis initiation transplants were less frequent in KTAs compared with MOTs. Use of high-quality grafts according to Kidney Donor Profile Index < 35% was frequent among MOTs, but uncommon in KTAs who had an Estimated Post Transplant Survival score (EPTS) of >20%. For recipients older than 65, SPKs and SOKs were rare, but SLKs and SHKs had a higher fraction of recipients than KTAs and were much more likely to use a Kidney Donor Profile Index <35% kidney. SPKs and KTAs with an EPTS ≤20% had the best kidney graft survival. KTAs with an EPTS ≤80% had better kidney graft survival than SLKs, SHKs, and SOKs. Conclusions. This study highlights disparities in access to deceased donor kidneys for kidney-alone candidates versus MOTs and suggests opportunities to improve allocation.
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Thongprayoon, Charat, Caroline C. Jadlowiec, Shennen A. Mao, Michael A. Mao, Napat Leeaphorn, Wisit Kaewput, Pattharawin Pattharanitima, Pitchaphon Nissaisorakarn, Matthew Cooper, and Wisit Cheungpasitporn. "Distinct phenotypes of kidney transplant recipients aged 80 years or older in the USA by machine learning consensus clustering." BMJ Surgery, Interventions, & Health Technologies 5, no. 1 (February 2023): e000137. http://dx.doi.org/10.1136/bmjsit-2022-000137.
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ObjectivesThis study aimed to identify distinct clusters of very elderly kidney transplant recipients aged ≥80 and assess clinical outcomes among these unique clusters.DesignCohort study with machine learning (ML) consensus clustering approach.Setting and participantsAll very elderly (age ≥80 at time of transplant) kidney transplant recipients in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database database from 2010 to 2019.Main outcome measuresDistinct clusters of very elderly kidney transplant recipients and their post-transplant outcomes including death-censored graft failure, overall mortality and acute allograft rejection among the assigned clusters.ResultsConsensus cluster analysis was performed in 419 very elderly kidney transplant and identified three distinct clusters that best represented the clinical characteristics of very elderly kidney transplant recipients. Recipients in cluster 1 received standard Kidney Donor Profile Index (KDPI) non-extended criteria donor (ECD) kidneys from deceased donors. Recipients in cluster 2 received kidneys from older, hypertensive ECD deceased donors with a KDPI score ≥85%. Kidneys for cluster 2 patients had longer cold ischaemia time and the highest use of machine perfusion. Recipients in clusters 1 and 2 were more likely to be on dialysis at the time of transplant (88.3%, 89.4%). Recipients in cluster 3 were more likely to be preemptive (39%) or had a dialysis duration less than 1 year (24%). These recipients received living donor kidney transplants. Cluster 3 had the most favourable post-transplant outcomes. Compared with cluster 3, cluster 1 had comparable survival but higher death-censored graft failure, while cluster 2 had lower patient survival, higher death-censored graft failure and more acute rejection.ConclusionsOur study used an unsupervised ML approach to cluster very elderly kidney transplant recipients into three clinically unique clusters with distinct post-transplant outcomes. These findings from an ML clustering approach provide additional understanding towards individualised medicine and opportunities to improve care for very elderly kidney transplant recipients.
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Matas, Arthur J., Kristen J. Gillingham, William D. Payne, David L. Dunn, Rainer W. G. Gruessner, David E. R. Sutherland, Walter Schmidt, and John S. Najarian. "A third kidney transplant: cost‐effective treatment for end‐stage renal disease?" Clinical Transplantation 10, no. 6pt1 (December 1996): 516–20. http://dx.doi.org/10.1111/j.1399-0012.1996.tb00738.x.
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AbstractGiven the organ donor shortage, some question whether a third kidney transplant can be justified. We studied the outcome of 51 third transplants (mean age 28±2 yr) done between 1 January 1985 and 31 December 1994. We compared hospital stay (mean±S.E.), cost, readmissions, readmission days, and outcome of third (vs. first and second) transplants. We found that patient survival for third transplants was equivalent to first and second transplants; graft survival was not as good. However, when third transplant recipients with recurrent disease (specifically, hemolytic uremic syndrome and focal sclerosis) were excluded from our analysis, we found no difference in 5‐yr graft survival (vs. first or second transplant recipients).Of the 51 third transplant recipients, 41 had a cadaver donor transplant. Third cadaver transplant recipients tended to have a longer hospital stay (p=NS) than first cadaver transplant recipients but had no more readmissions or readmission days than first or second cadaver transplant recipients.Employment data are available for 28 third transplant recipients; 16 (57%) are currently working or going to school. Of the 21 recipients who responded to quality of life questionnaires, 17 (81%) reported being healthy and all 21 (100%) said transplantation was not a drawback to their health. We conclude that third transplants should be considered for selected patients with renal failure whose first or second transplants have failed. Such patients can often be successfully transplanted.
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Tingle, Samuel J., Nicholas D. H. Chung, Abdullah K. Malik, Georgios Kourounis, Emily Thompson, Emily K. Glover, Jennifer Mehew, et al. "Donor Time to Death and Kidney Transplant Outcomes in the Setting of a 3-Hour Minimum Wait Policy." JAMA Network Open 7, no. 11 (November 14, 2024): e2443353. http://dx.doi.org/10.1001/jamanetworkopen.2024.43353.
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ImportanceLengthening waiting lists for organ transplant mandates the development of strategies to expand the deceased donor pool. Due to concerns regarding organ viability, most organ donation organizations internationally wait no longer than 1 to 2 hours for potential donation after circulatory death (DCD), possibly underutilizing an important organ source; UK policy mandates a minimum 3-hour wait time.ObjectiveTo assess whether time to death (TTD) from withdrawal of life-sustaining treatment (WLST) is associated with kidney transplant outcomes.Design, Setting, and ParticipantsThis population-based cohort study used data from the prospectively maintained UK Transplant Registry from all 23 UK kidney transplant centers from January 1, 2013, to December 31, 2021; follow-up was until the date of data extraction (October 2023). Participants comprised 7183 adult recipients of DCD kidney-alone transplants.ExposureDuration of TTD, defined as time from WLST to donor mechanical asystole.Main Outcomes and MeasuresPrimary outcome was 12-month estimated glomerular filtration rate (eGFR; for the main eGFR model, variables with significant right skew [histogram visual assessment] were analyzed on the log2 scale), with secondary outcomes of delayed graft function and graft survival (censored at death or 5 years).ResultsThis study included 7183 kidney transplant recipients (median age, 56 years [IQR, 47-64 years]; 4666 men [65.0%]). Median donor age was 55 years (IQR, 44-63 years). Median TTD was 15 minutes (range, 0-407 minutes), with 885 kidneys transplanted from donors with TTD over 1 hour and 303 kidneys transplanted from donors with TTD over 2 hours. Donor TTD was not associated with recipient 12-month eGFR on adjusted linear regression (change per doubling of TTD, −0.25; 95% CI, −0.68 to 0.19; P = .27), nor with delayed graft function (adjusted odds ratio, 1.01; 95% CI, 0.97-1.06; P = .65) or graft survival (adjusted hazard ratio, 1.00; 95% CI, 0.95-1.07; P = .92). These findings were confirmed with restricted cubic spline models (assessing nonlinear associations) and tests of interaction (including normothermic regional perfusion). In contrast, donor asystolic time, cold ischemic time, and reperfusion time were independently associated with outcomes. Compared with a theoretical 1-hour maximum wait time, the UK policy (minimum 3-hour wait time) has been associated with 885 extra DCD transplants compared with 6298 transplants (14.1% increase).Conclusions and RelevanceIn this cohort study of DCD kidney recipients, donor TTD was not associated with posttransplant outcomes, in contrast to subsequent ischemic times. Altering international transplant practice to mandate minimum 3-hour donor wait times could substantially increase numbers of kidney transplants performed without prejudicing outcomes.
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MANAN, FE, KU REHMAN, I. ULLAH, and DR SHAHINDA. "INCIDENCE OF KIDNEY STONES IN KIDNEY TRANSPLANT RECIPIENTS." Biological and Clinical Sciences Research Journal 2024, no. 1 (February 17, 2024): 709. http://dx.doi.org/10.54112/bcsrj.v2024i1.709.
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The incidence of kidney stones in kidney transplant recipients is a significant concern within the realm of post-transplant complications. The study's main objective is to find the incidence of kidney stones in kidney transplant recipients. This retrospective study was conducted at the Institute of Kidney Diseases Peshawar from 2017 to 2023. Data was collected from 420 kidney transplant patients. All patients above 18 years with available medical records who underwent renal transplants in IKD and outside IKD and who presented to IKD for follow-up were included in the study—patients with a history of kidney stones before the transplant process were excluded. Demographic information, including age, gender, and pre-transplant comorbidities, was recorded for each patient. Data were collected from 420 patients with kidney transplants. Out of 420 patients, 35 patients developed kidney stones after transplantation. The mean age of the patients who developed stones was 48.7 ± 10.2 years. There were 45.7% male and 54.3% female patients in the kidney stone group. 25.7% of patients had pre-transplant DM. Most kidney stones analyzed in the study comprised calcium oxalate, representing 18 cases, followed by calcium phosphate with eight instances. The correlation analysis revealed that age and gender did not significantly correlate with kidney stone formation in transplant patients, with p-values of 0.32 and 0.17, respectively. It is concluded that kidney transplant recipients exhibit a notable incidence of kidney stone formation, with tacrolimus-based immunosuppressive regimens potentially contributing to this risk. While age and pre-transplant diabetes show trends toward association with kidney stone development.
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Hoang, Giang, Hong Son Trinh, and Viet Cuong Pham. "Approaches to managing the list of patients waiting for kidney transplantation." Ministry of Science and Technology, Vietnam 66, no. 5 (May 25, 2024): 34–39. http://dx.doi.org/10.31276/vjst.66(5).34-39.
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Objective: Describe an overview of the management of the list of patients waiting for a kidney transplant in the world and propose a model for the management of the list of patients waiting for a kidney transplant in Vietnam. Methods: Literature review and analysis of strengths, weaknesses, opportunities, and threats in managing the list of patients waiting for a kidney transplant. Results: The model of managing the list of patients waiting for a kidney transplant in America, Europe, Japan, and China has many similarities. The management of the list of patients waiting for a kidney transplant is unified nationwide. Patients can only receive a kidney transplant when their name is on the national transplant waiting list. Only one organization is allowed to distribute kidney transplants based on the compatibility between donor and recipient. Vietnam has performed 7,380 kidney transplants, however, up to now, Vietnam still hasn't had a national list of patients waiting for kidney transplants. The models of managing patients waiting for kidney transplants of America and Japan have many advantages, as well as China’s management experience, which is suitable for Vietnam’s oriented development. Conclusions: Managing the list of patients waiting for a kidney transplant according to the models of America, Japan and learning from China’s experience is considered a suitable direction for the model of the national list of patients waiting for kidney transplants in Vietnam.
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Gunawardena, Thilina, and Dan Ridgway. "Transplant Nephrectomy: Current Concepts." Saudi Journal of Kidney Diseases and Transplantation 33, no. 5 (2022): 716–25. http://dx.doi.org/10.4103/1319-2442.389431.
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Kidney transplantation is the gold standard treatment option for patients with endstage kidney disease. As the number of waitlisted patients increases, the gap between supply and demand for suitable donor kidneys keeps widening. The adoption of novel strategies that expand the donor pool has attenuated this issue to a certain degree, and this has led to a progressive increase in the number of annual transplants performed. As transplanted kidneys have a finite lifespan, there is a reciprocal rise in the number of patients who return to dialysis once their allograft fails. The clinicians involved in the management of such patients are left with the problem of managing the nonfunctioning allograft. The decision to undertake transplant nephrectomy (TN) in these patients is not straightforward. Allograft nephrectomy is a procedure that is associated with significant morbidity and mortality. It will have implications for the outcomes of the subsequent transplant. In this review, we aimed to compressively discuss the indications, techniques, and outcomes of TN, which is an integral component of the management of a failing allograft.
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A, Vathsala, and Khuan Yew Chow. "Renal Transplantation in Singapore." Annals of the Academy of Medicine, Singapore 38, no. 4 (April 15, 2009): 291–99. http://dx.doi.org/10.47102/annals-acadmedsg.v38n4p291.
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Introduction: Renal transplantation is the best treatment for kidney failure. As the demand far exceeds the supply, various legislative measures have been put into place in Singapore to increase kidney transplant rates. This paper evaluates the impact of these measures and reports on the outcomes for kidney transplant recipients in Singapore. Materials and Methods: Patient demographics, recipient and donor characteristics, and co-morbidities occurring in incident transplant patients were extracted from Singapore Renal Registry (SRR) Reports from 1997 to 2006, tabulated and summarised. Graft and patient survivals data, which were calculated by Kaplan-Meier analysis until return to dialysis/pre-emptive renal re-transplant or patient death respectively, were extracted from SRR Reports. Published data from the United States Renal Data System (USRDS) and Organ Procurement and Transplantation Network (OPTN) were used for comparisons with data from the SRR. Results: The introduction of the Human Organ Transplant Act increased the rate of deceased donor (DD) kidney transplants from 4.7 per year from 1970 to 1988, to 41.4 per year from 1988 to 2004. In 2006, the overall DD and living donor (LD) rate for kidney transplants performed locally for Singaporeans and permanent residents of Singapore was 22.6 per million population (pmp); taking into account overseas kidney transplants, the kidney transplant rate was 33.0 pmp. One and 5-year graft survivals for local LD and DD transplanted between 1999 and 2006, as reported by the SRR, were 98.1% and 95.3% versus 88.9% and 81.3%, respectively (P <0.001). Patient survivals at 1 and 5 years were likewise significantly better for LD versus DD (99.4% and 96.6% vs. 96% and 89.1%, respectively; P = 0.005). Conclusions: The local kidney transplant rates were lower than those reported by the USRDS for the USA, Spain, Norway and Australia but higher than other Asian countries. While 1-year outcomes for transplants reported to the SRR were similar to that reported by the OPTN, 5-year survivals were significantly higher, possibly due to the selection of patients with fewer co- morbidities for kidney transplantation in Singapore. These results suggest that while outcomes are excellent, there is much more to be done to increase kidney transplantation rates in Singapore so as to meet the needs of end-stage renal failure patients in the country. Key words: Presumed consent, Singapore Renal Registry, Living donor, Kidney transplant, Deceased donor kidney transplant, Graft survival
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Gruttadauria, Michelle, Colin Dunn, Juan Lin, Joshua R. Kaminetsky, Kayla Applebaum, Daniella Portal, Omar Mohammed, Juan Rocca, and Stuart Greenstein. "Patients’ Expectations for Longevity of Kidney Transplant." Progress in Transplantation 29, no. 1 (December 4, 2018): 48–53. http://dx.doi.org/10.1177/1526924818817045.
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Introduction: Prior to transplantation, the transplant team is responsible for transplant education and posttransplant expectations. The majority of outcomes research focuses on 1- and 3-year graft survival, with a lack of literature focused upon whether patients have a realistic understanding of how many years deceased donor kidneys can be expected to function after transplant. Objective: To determine whether potential kidney transplant patients’ expectations for how long a deceased donor kidney will function after transplantation differs from transplant surgeons, using quantitative analysis. Design: A cross-sectional survey was used with potential adult kidney transplant recipients and transplant surgeons. Patient surveys included demographics, quality-of-life questions, and questions of expectations of kidney function for deceased donor kidneys from the Kidney Donor Profile Index. The survey categorized donor organ risk as 0% to 20%, 21% to 85%, and 86% to 100%, and results were compared to responses from US Transplant Surgeons. Surgeons were contacted via e-mail using an online survey program. Results: Responses included 154 transplant surgeons and 172 patients. Surgeon and patient responses were compared using Fisher exact test, showing a significant difference in each of the donor organ categories. We found that 47% of patient respondents did not correctly interpret the Kidney Donor Profile Index continuum. Conclusion: In every organ donor category, patients had a significantly different expectation for how long a transplanted kidney will last after transplant when compared to transplant surgeons. More study is required to determine why 47% of patients did not correctly interpret the Kidney Donor Profile continuum.
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Thongprayoon, Charat, Shennen A. Mao, Caroline C. Jadlowiec, Michael A. Mao, Napat Leeaphorn, Wisit Kaewput, Pradeep Vaitla, et al. "Machine Learning Consensus Clustering of Morbidly Obese Kidney Transplant Recipients in the United States." Journal of Clinical Medicine 11, no. 12 (June 8, 2022): 3288. http://dx.doi.org/10.3390/jcm11123288.
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Background: This study aimed to better characterize morbidly obese kidney transplant recipients, their clinical characteristics, and outcomes by using an unsupervised machine learning approach. Methods: Consensus cluster analysis was applied to OPTN/UNOS data from 2010 to 2019 based on recipient, donor, and transplant characteristics in kidney transplant recipients with a pre-transplant BMI ≥ 40 kg/m2. Key cluster characteristics were identified using the standardized mean difference. Post-transplant outcomes, including death-censored graft failure, patient death, and acute allograft rejection, were compared among the clusters. Results: Consensus clustering analysis identified 3204 kidney transplant recipients with a BMI ≥ 40 kg/m2. In this cohort, five clinically distinct clusters were identified. Cluster 1 recipients were predominantly white and non-sensitized, had a short dialysis time or were preemptive, and were more likely to receive living donor kidney transplants. Cluster 2 recipients were older and diabetic. They were likely to have been on dialysis >3 years and receive a standard KDPI deceased donor kidney. Cluster 3 recipients were young, black, and had kidney disease secondary to hypertension or glomerular disease. Cluster 3 recipients had >3 years of dialysis and received non-ECD, young, deceased donor kidney transplants with a KDPI < 85%. Cluster 4 recipients were diabetic with variable dialysis duration who either received non-ECD standard KDPI kidneys or living donor kidney transplants. Cluster 5 recipients were young retransplants that were sensitized. One-year patient survival in clusters 1, 2, 3, 4, and 5 was 98.0%, 94.4%, 98.5%, 98.7%, and 97%, and one-year death-censored graft survival was 98.1%, 93.0%, 96.1%, 98.8%, and 93.0%, respectively. Cluster 2 had the worst one-year patient survival. Clusters 2 and 5 had the worst one-year death-censored graft survival. Conclusions: With the application of unsupervised machine learning, variable post-transplant outcomes are observed among morbidly obese kidney transplant recipients. Recipients with earlier access to transplant and living donation show superior outcomes. Unexpectedly, reduced graft survival in cluster 3 recipients perhaps underscores socioeconomic access to post-transplant support and minorities being disadvantaged in access to preemptive and living donor transplants. Despite obesity-related concerns, one-year patient and graft survival were favorable in all clusters, and obesity itself should be reconsidered as a hard barrier to kidney transplantation.
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YOO, Jongwon. "Social Determinants of Health in Access to Repeat Kidney Transplantation." Korean Journal of Health Promotion 24, no. 2 (June 30, 2024): 83–91. http://dx.doi.org/10.15384/kjhp.2024.00045.
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Background: The longevity of transplanted kidney grafts is limited, and more than half of kidney transplant patients need repeat transplants during their lifetimes. However, inequity in access to repeat kidney transplants, especially that resulting from social determinants of health, has not been studied. Methods: Using national data, this retrospective study analyzed kidney transplant recipients with failed kidney grafts (n=63,635) between October 1, 1987, and August 31, 2015, in the United States. Results: After controlling the clinical covariates (i.e., primary disease, panel reactive antibody), age, race, education level, insurance type, and job status significantly impacted access to the kidney transplant waiting list after kidney graft failure. Higher odds of waiting-list access were evident among patients who were younger, White, and fully employed and who had private insurance and a college degree. A Cox proportional hazard model indicated that age, race, and insurance type impacted how long patients waited until being listed. Compared with patients younger than 71 years, those 71 years or older had a shorter duration until being wait-listed, with a hazard ratio (HR) of 1.84 (95% confidence interval [CI], 1.369–2.463; P<0.001). By contrast, Black patients waited longer to be wait-listed compared with White patients, with an HR of 0.75 (95% CI, 0.704–0.803; P<0.001). Moreover, of all insurance types, patients with public insurance (Medicare) experienced the longest duration to being re-listed. Conclusion: Efforts to alleviate the impact of social determinants of health should start earlier following the initial transplant. Improving access to repeat kidney transplants will build transparency and trust in our transplant community, ultimately helping to achieve the best health outcomes.
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Oumayma, Ratbi, Ouadghiri Sanae, Yakhlef Imane, Atouf Ouafae, and Essakalli Malika. "COMPARAISON DES RESULTATS A LONG TERME DE LA TRANSPLANTATION RENALE ENTRE CONJOINTS ET DONNEURS VIVANTS APPARENTES: EXPERIENCE MONOCENTRIQUE AU MAROC." International Journal of Advanced Research 12, no. 07 (July 31, 2024): 264–71. http://dx.doi.org/10.21474/ijar01/19051.
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Objective: End-stage kidney disease is a serious medical condition that often requires a kidney transplant. This single-center study, conducted in Morocco, examines the long-term outcomes of kidney transplants from spouses and related living donors. The goal is to enhance access to organ transplantation by assessing the success of transplants using spouses as donors. Patients and methods:A total of 117 patients were eligible for a kidney transplant from their spouses kidneys. Out of these, 36 received a transplant and were compared to 56 patients who received a kidney from a related donor. Demographic, clinical, and immunological data, as well as long-term outcomes, including graft survival, were analyzed. Results: Recipientswerepredominantly male in both groups (69.6% versus 83.3%). Recipients in the related group wereyoungerthanthose in the unrelated group (39.80 versus 56.56 years). Relatedgraftsshowed more HLA matchingthanunrelatedgrafts (4.45 versus 1.64). The occurrence of DSA after transplantation wasslightlylower in the relatedgraft (16.1% versus 19.4%). Graftsurvival at 1, 3, 5, and 10 yearswassimilar in both groups, with a slight favorable trend for the related group. Conclusion: Kidney transplant survival rates are broadlysimilarbetweenspouses and related living donors. This suggeststhatspousal donation can compensate for the scarcity of cadaveric donation, particularly in Morocco.
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King, Kristen L., S. Ali Husain, Miko Yu, Joel T. Adler, Jesse Schold, and Sumit Mohan. "Characterization of Transplant Center Decisions to Allocate Kidneys to Candidates With Lower Waiting List Priority." JAMA Network Open 6, no. 6 (June 5, 2023): e2316936. http://dx.doi.org/10.1001/jamanetworkopen.2023.16936.
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ImportanceAllocation of deceased donor kidneys is meant to follow a ranked match-run list of eligible candidates, but transplant centers with a 1-to-1 relationship with their local organ procurement organization have full discretion to decline offers for higher-priority candidates and accept them for lower-ranked candidates at their center.ObjectiveTo describe the practice and frequency of transplant centers placing deceased donor kidneys with candidates who are not the highest rank at their center according to the allocation algorithm.Design, Setting, and ParticipantsThis retrospective cohort study used 2015 to 2019 organ offer data from US transplant centers with a 1-to-1 relationship with their local organ procurement organization, following candidates for transplant events from January 2015 to December 2019. Participants were deceased kidney donors with a single match-run and at least 1 kidney transplanted locally and adult, first-time, kidney-only transplant candidates receiving at least 1 offer for a locally transplanted deceased donor kidney. Data were analyzed from March 1, 2022 to March 28, 2023.ExposureDemographic and clinical characteristics of donors and recipients.Main Outcomes and MeasuresThe outcome of interest was kidney transplantation into the highest-priority candidate (defined as transplanted after zero declines for local candidates in the match-run) vs a lower-ranked candidate.ResultsThis study assessed 26 579 organ offers from 3136 donors (median [IQR] age, 38 [25-51] years; 2903 [62%] men) to 4668 recipients. Transplant centers skipped their highest-ranked candidate to place kidneys further down the match-run for 3169 kidneys (68%). These kidneys went to a median (IQR) of the fourth- (third- to eighth-) ranked candidate. Higher kidney donor profile index (KDPI; higher score indicates lower quality) kidneys were less likely to go to the highest-ranked candidate, with 24% of kidneys with KDPI of at least 85% going to the top-ranked candidate vs 44% of KDPI 0% to 20% kidneys. When comparing estimated posttransplant survival (EPTS) scores between the skipped candidates and the ultimate recipients, kidneys were placed with recipients with both better and worse EPTS than the skipped candidates, across all KDPI risk groups.Conclusions and RelevanceIn this cohort study of local kidney allocation at isolated transplant centers, we found that centers frequently skipped their highest-priority candidates to place kidneys further down the allocation prioritization list, often citing organ quality concerns but placing kidneys with recipients with both better and worse EPTS with nearly equal frequency. This occurred with limited transparency and highlights the opportunity to improve the matching and offer algorithm to improve allocation efficiency.
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Manton, MSW, Bradley, and Caroline Jennette Poulton, MSW. "African-American Attitudes Toward Kidney Transplant: A Comparative Analysis." Journal of Nephrology Social Work 37, no. 1 (October 1, 2013): 19–28. http://dx.doi.org/10.61658/jnsw.v37i1.75.
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Racial disparities in kidney transplantation continue to persist despite voluminous studies attempting to address this problem. We conducted 26 semi-structured, one-on-one interviews with African-American and Caucasian dialysis patients to analyze whether or not there is a difference in attitudes toward kidney transplantation and whether or not this contributes to these disparities. Pre-dialysis education strongly correlates with a person’s willingness to get listed, while fear of surgery and care of the transplanted kidney, and interaction with peers who have gone through a failed kidney transplant, decrease the chances of getting listed. Subjects did not report racial bias in being referred or worked up for transplant. African Americans were more likely to weigh the pros and cons of transplants while Caucasians were more likely to see dialysis as temporary and viewed transplant as the default treatment for their kidney failure. All dialysis patients, but especially African Americans, may benefit from transplant education tailored to address specific patient concerns.
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Husain, S. Ali, Kristen L. King, Geoffrey K. Dube, Demetra Tsapepas, David J. Cohen, Lloyd E. Ratner, and Sumit Mohan. "Regional Disparities in Transplantation With Deceased Donor Kidneys With Kidney Donor Profile Index Less Than 20% Among Candidates With Top 20% Estimated Post Transplant Survival." Progress in Transplantation 29, no. 4 (September 10, 2019): 354–60. http://dx.doi.org/10.1177/1526924819874699.
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Introduction: The Kidney Allocation System in the United States prioritizes candidates with Estimated Post-Transplant Survival (EPTS) ≤20% to receive deceased donor kidneys with Kidney Donor Profile Index (KDPI) ≤20%. Research Question: We compared access to KDPI ≤ 20% kidneys for EPTS ≤ 20% candidates across the United States to determine whether geographic disparities in access to these low KDPI kidneys exist. Design: We identified all incident adult deceased donor kidney candidates wait-listed January 1, 2015, to March 31, 2018, using United Network for Organ Sharing data. We calculated the proportion of candidates transplanted, final EPTS, and KDPI of transplanted kidneys for candidates listed with EPTS ≤ 20% versus >20%. We compared the odds of receiving a KDPI ≤ 20% deceased donor kidney for EPTS ≤ 20% candidates across regions using logistic regression. Results: Among 121 069 deceased donor kidney candidates, 28.5% had listing EPTS ≤ 20%. Of these, 16.1% received deceased donor kidney transplants (candidates listed EPTS > 20%: 17.1% transplanted) and 12.3% lost EPTS ≤ 20% status. Only 49.4% of transplanted EPTS ≤ 20% candidates received a KDPI ≤ 20% kidney, and 48.3% of KDPI ≤ 20% kidneys went to recipients with EPTS > 20% at the time of transplantation. Odds of receiving a KDPI ≤ 20% kidney were highest in region 6 and lowest in region 9 (odds ratio 0.19 [0.13 to 0.28]). The ratio of KDPI ≤ 20% donors per EPTS ≤ 20% candidate and likelihood of KDPI ≤ 20% transplantation were strongly correlated ( r 2 = 0.84). Discussion: Marked geographic variation in the likelihood of receiving a KDPI ≤ 20% deceased donor kidney among transplanted EPTS ≤ 20% candidates exists and is related to differences in organ availability within allocation borders. Policy changes to improve organ sharing are needed to improve equity in access to low KDPI kidneys.
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Dumbill, Richard, Roderick Jaques, Matthew Robb, Rachel Johnson, Rutger J. Ploeg, Maria E. Kaisar, and Edward J. Sharples. "Transplant and Recipient Factors in Prediction of Kidney Transplant Outcomes: A UK-Wide Paired Analysis." Journal of Clinical Medicine 11, no. 8 (April 15, 2022): 2222. http://dx.doi.org/10.3390/jcm11082222.
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Background: In kidney transplantation, the relative contribution of various donor, procedure and recipient-related factors on clinical outcomes is unknown. Previous paired studies have largely focused on examining factors predicting early outcomes, where the effect of donor factors is thought to be most important. Here, we sought to examine the relationship between early and long-term outcomes in a UK-wide paired kidney analysis. Methods: UK Transplant Registry data covering 24,090 kidney transplants performed between 2001–2018, where both kidneys from each donor were transplanted, were analysed. Case-control studies were constructed using matched pairs of kidneys from the same donor discordant for outcome, to delineate the impact of transplant and recipient factors on longer-term outcomes. Results: Multivariable conditional logistic regression identified HLA mismatch as an important predictor of prolonged delayed graft function (DGF), in the context of a paired study controlling for the influence of donor factors, even when adjusting for early acute rejection. Prolonged DGF, but not human leucocyte antigen (HLA) mismatch, strongly predicted 12-month graft function, and impaired 12-month graft function was associated with an increased risk of graft failure. Conclusions: This study indicates prolonged DGF is associated with adverse long-term outcomes and suggests that alloimmunity may contribute to prolonged DGF by a mechanism distinct from typical early acute rejection.
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Khan, Raza Muhammad, Najam Ud Din Mufti, Waqas Sardar, Abdul Haseeb, Saad Hanan, and Ahmad Zeb Khan. "A Single Center's Experience with BK-Virus Frequency in Post-Renal Transplant Patients in IKD Peshawar." Pakistan Journal of Medical and Health Sciences 16, no. 6 (June 30, 2022): 694–96. http://dx.doi.org/10.53350/pjmhs22166694.
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Objective: To measure the incidence of BK-Virus infection, treatment, and complications among patients who had kidney transplants at the Institute of Kidney Diseases (IKD) in Peshawar, Pakistan. Methodology: The single center experience retrospective study was conducted in IKD Peshawar, Pakistan from January to December 2021. Clinical and analytical data was gathered. Blood samples were tested for BK virus load using quantitative DNA-polymerase chain reaction (PCR). Results: A total of 131 patients were examined. Of the 131 participants, 117 (89.4%) were males and 14 (10.6%) were females, with a mean age of 30.04 5.41. All of the patients received a transplant from a blood relative. After six months, the BK-Virus plasma PCR was found to be positive in eight patients (6.2%) who had had kidney transplantation. Conclusion: Patients who have had a kidney transplant and are on induction treatment or other forms of immune-suppression are at an increased risk of contracting the BK-Virus infection. Immunosuppressive medicines should be reduced to the barest minimum for effective treatment. Keywords: Transplanted Kidneys, BK Virus.
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Buchberger, David, Paul Kreinbrink, and Jordan Kharofa. "Proton Therapy in the Treatment of Anal Cancer in Pelvic Kidney Transplant Recipients: A Case Series." International Journal of Particle Therapy 6, no. 1 (June 1, 2019): 28–34. http://dx.doi.org/10.14338/ijpt-19-00067.1.
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Abstract Purpose: The incidence of anal cancer in patients with kidney transplants has increased. The definitive treatment for anal cancer is chemotherapy and intensity-modulated radiation therapy. In kidney transplant recipients, sparing the pelvic kidney in the process of delivering radiation to the anus can be challenging. Intensity-modulated proton therapy (IMPT) has been proposed as an alternative to intensity-modulated radiation therapy for the treatment of anal cancer in this population, given its increased ability to spare organs-at-risk. Case Series: We present 4 cases of patients with transplanted pelvic kidneys who subsequently developed anal cancer and were treated with IMPT from 2017 to 2019. Conclusion: Use of IMPT appears to be an acceptable option for the treatment of anal cancer in patients with a pelvic kidney.
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Teltser, Keith F. "Do Kidney Exchanges Improve Patient Outcomes?" American Economic Journal: Economic Policy 11, no. 3 (August 1, 2019): 427–53. http://dx.doi.org/10.1257/pol.20170678.
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In this paper, I estimate the number of additional transplants generated by kidney exchanges. To do this, I analyze substitution patterns between exchange transplants and other transplant outcomes. Exploiting variation in patients exposure to exchange activity across time and place, I find that 64 percent of exchange transplants represent new living donor transplants. Using the same approach, I find that an increase in the probability of receiving an exchange transplant reduces the probability of graft failure and reduces time spent waiting for a kidney. Back-of-the-envelope calculations suggest that each exchange transplant increases social welfare by $300,000 to $700,000. (JEL D47, I11, I12, I18)
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Wesselman, Hannah, Christopher Graham Ford, Yuridia Leyva, Xingyuan Li, Chung-Chou H. Chang, Mary Amanda Dew, Kellee Kendall, et al. "Social Determinants of Health and Race Disparities in Kidney Transplant." Clinical Journal of the American Society of Nephrology 16, no. 2 (January 28, 2021): 262–74. http://dx.doi.org/10.2215/cjn.04860420.
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Background and objectivesBlack patients have a higher incidence of kidney failure but lower rate of deceased- and living-donor kidney transplantation compared with White patients, even after taking differences in comorbidities into account. We assessed whether social determinants of health (e.g., demographics, cultural, psychosocial, knowledge factors) could account for race differences in receiving deceased- and living-donor kidney transplantation.Design, setting, participants, & measurementsVia medical record review, we prospectively followed 1056 patients referred for kidney transplant (2010–2012), who completed an interview soon after kidney transplant evaluation, until their kidney transplant. We used multivariable competing risk models to estimate the cumulative incidence of receipt of any kidney transplant, deceased-donor transplant, or living-donor transplant, and the factors associated with each outcome.ResultsEven after accounting for social determinants of health, Black patients had a lower likelihood of kidney transplant (subdistribution hazard ratio, 0.74; 95% confidence interval, 0.55 to 0.99) and living-donor transplant (subdistribution hazard ratio, 0.49; 95% confidence interval, 0.26 to 0.95), but not deceased-donor transplant (subdistribution hazard ratio, 0.92; 95% confidence interval, 0.67 to 1.26). Black race, older age, lower income, public insurance, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, less transplant knowledge, and fewer learning activities were each associated with a lower probability of any kidney transplant. Older age, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, and fewer learning activities were each associated with a lower probability of deceased-donor transplant. Black race, older age, lower income, public insurance, higher body mass index, dialysis before kidney transplant, not presenting with a potential living donor, religious objection to living-donor transplant, and less transplant knowledge were each associated with a lower probability of living-donor transplant.ConclusionsRace and social determinants of health are associated with the likelihood of undergoing kidney transplant.
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de Arruda, Germano José Ferraz, Andres M. Abularach, Márcio Gatti, Pedro F. Arruda, and Fernando N. Fácio. "Partial Nephrectomy of Transplanted Kidney with Calyceal Fistula." Saudi Journal of Kidney Diseases and Transplantation 33, no. 4 (2022): 582–85. http://dx.doi.org/10.4103/1319-2442.388193.
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Kidney transplant is the established treatment for patients with chronic kidney disease but is associated with complications due to the complexity of the procedure. Calyceal fistulas are rare urological complications in transplants caused by arterial occlusion with segmental infarction of the graft. Treatment is based on the extension of the affected area and the clinical status of the patient. For extensive infarctions treated surgically, a total nephrectomy of the transplanted kidney is generally performed. We present a case of a transplanted kidney with polar necrosis and calyceal fistula treated with partial nephrectomy of the affected area, maintaining the graft and preserving kidney function.
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Thongprayoon, Charat, Jing Miao, Caroline C. Jadlowiec, Shennen A. Mao, Michael A. Mao, Napat Leeaphorn, Wisit Kaewput, et al. "Differences between Kidney Transplant Recipients from Deceased Donors with Diabetes Mellitus as Identified by Machine Learning Consensus Clustering." Journal of Personalized Medicine 13, no. 7 (July 3, 2023): 1094. http://dx.doi.org/10.3390/jpm13071094.
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Clinical outcomes of deceased donor kidney transplants coming from diabetic donors currently remain inconsistent, possibly due to high heterogeneities in this population. Our study aimed to cluster recipients of diabetic deceased donor kidney transplants using an unsupervised machine learning approach in order to identify subgroups with high risk of inferior outcomes and potential variables associated with these outcomes. Consensus cluster analysis was performed based on recipient-, donor-, and transplant-related characteristics in 7876 recipients of diabetic deceased donor kidney transplants from 2010 to 2019 in the OPTN/UNOS database. We determined the important characteristics of each assigned cluster and compared the post-transplant outcomes between the clusters. Consensus cluster analysis identified three clinically distinct clusters. Recipients in cluster 1 (n = 2903) were characterized by oldest age (64 ± 8 years), highest rate of comorbid diabetes mellitus (55%). They were more likely to receive kidney allografts from donors that were older (58 ± 6.3 years), had hypertension (89%), met expanded criteria donor (ECD) status (78%), had a high rate of cerebrovascular death (63%), and carried a high kidney donor profile index (KDPI). Recipients in cluster 2 (n = 687) were younger (49 ± 13 years) and all were re-transplant patients with higher panel reactive antibodies (PRA) (88 [IQR 46, 98]) who received kidneys from younger (44 ± 11 years), non-ECD deceased donors (88%) with low numbers of HLA mismatch (4 [IQR 2, 5]). The cluster 3 cohort was characterized by first-time kidney transplant recipients (100%) who received kidney allografts from younger (42 ± 11 years), non-ECD deceased donors (98%). Compared to cluster 3, cluster 1 had higher incidence of primary non-function, delayed graft function, patient death and death-censored graft failure, whereas cluster 2 had higher incidence of delayed graft function and death-censored graft failure but comparable primary non-function and patient death. An unsupervised machine learning approach characterized diabetic donor kidney transplant patients into three clinically distinct clusters with differing outcomes. Our data highlight opportunities to improve utilization of high KDPI kidneys coming from diabetic donors in recipients with survival-limiting comorbidities such as those observed in cluster 1.
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Bellini, Maria Irene, Aisling E. Courtney, and Jennifer A. McCaughan. "Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants." Journal of Clinical Medicine 9, no. 7 (July 5, 2020): 2118. http://dx.doi.org/10.3390/jcm9072118.
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Background: Failed kidney transplant recipients benefit from a new graft as the general incident dialysis population, although additional challenges in the management of these patients are often limiting the long-term outcomes. Previously failed grafts, a long history of comorbidities, side effects of long-term immunosuppression and previous surgical interventions are common characteristics in the repeated kidney transplantation population, leading to significant complex immunological and technical aspects and often compromising the short- and long-term results. Although recipients’ factors are acknowledged to represent one of the main determinants for graft and patient survival, there is increasing interest in expanding the donor’s pool safely, particularly for high-risk candidates. The role of living kidney donation in this peculiar context of repeated kidney transplantation has not been assessed thoroughly. The aim of the present study is to analyse the effects of a high-quality graft, such as the one retrieved from living kidney donors, in the repeated kidney transplant population context. Methods: Retrospective analysis of the outcomes of the repeated kidney transplant population at our institution from 1968 to 2019. Data were extracted from a prospectively maintained database and stratified according to the number of transplants: 1st, 2nd or 3rd+. The main outcomes were graft and patient survivals, recorded from time of transplant to graft failure (return to dialysis) and censored at patient death with a functioning graft. Duration of renal replacement therapy was expressed as cumulative time per month. A multivariate analysis considering death-censored graft survival, decade of transplantation, recipient age, donor age, living donor, transplant number, ischaemic time, time on renal replacement therapy prior to transplant and HLA mismatch at HLA-A, -B and -DR was conducted. In the multivariate analysis of recipient survival, diabetic nephropathy as primary renal disease was also included. Results: A total of 2395 kidney transplant recipients were analysed: 2062 (83.8%) with the 1st kidney transplant, 279 (11.3%) with the 2nd graft, 46 (2.2%) with the 3rd+. Mean age of 1st kidney transplant recipients was 43.6 ± 16.3 years, versus 39.9 ± 14.4 for 2nd and 41.4 ± 11.5 for 3rd+ (p < 0.001). Aside from being younger, repeated kidney transplant patients were also more often males (p = 0.006), with a longer time spent on renal replacement therapy (p < 0.0001) and a higher degree of sensitisation, expressed as calculated reaction frequency (p < 0.001). There was also an association between multiple kidney transplants and better HLA match at transplantation (p < 0.0001). A difference in death-censored graft survival by number of transplants was seen, with a median graft survival of 328 months for recipients of the 1st transplant, 209 months for the 2nd and 150 months for the 3rd+ (p = 0.038). The same difference was seen in deceased donor kidneys (p = 0.048), but not in grafts from living donors (p = 0.2). Patient survival was comparable between the three groups (p = 0.59). Conclusions: In the attempt to expand the organ donor pool, particular attention should be reserved to high complex recipients, such as the repeated kidney transplant population. In this peculiar context, the quality of the donor has been shown to represent a main determinant for graft survival—in fact, kidney retrieved from living donors provide comparable outcomes to those from single-graft recipients.
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Fabrizi, Fabrizio, Roberta Cerutti, Carlo M. Alfieri, and Piergiorgio Messa. "Updated View on Kidney Transplant from HCV-Infected Donors and DAAs." Pharmaceutics 13, no. 4 (April 6, 2021): 496. http://dx.doi.org/10.3390/pharmaceutics13040496.
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Background: The discrepancy between the number of potential available kidneys and the number of patients listed for kidney transplant continues to widen all over the world. The transplant of kidneys from hepatitis C virus (HCV)-infected donors into HCV naïve recipients has grown recently because of persistent kidney shortage and the availability of direct-acting antiviral agents. This strategy has the potential to reduce both waiting times for transplant and the risk of mortality in dialysis. Aim: We made an extensive review of the scientific literature in order to review the efficacy and safety of kidney transplant from HCV-viremic donors into HCV naïve recipients who received early antiviral therapy with direct-acting antiviral agents (DAAs). Results: Evidence has been rapidly accumulated on this topic and some reports have been published (n = 11 studies, n = 201 patients) over the last three years. Various combinations of DAAs were administered—elbasvir/grazoprevir (n = 38), glecaprevir/pibrentasvir (n = 110), and sofosbuvir-based regimens (n = 53). DAAs were initiated in a range between a few hours before renal transplant (RT) to a median of 76 days after RT. The sustained virological response (SVR) rate was between 97.5% and 100%. A few severe adverse events (SAEs) were noted including fibrosing cholestatic hepatitis (n = 3), raised serum aminotransferase levels (n = 11), and acute rejection (n = 7). It remains unclear whether the AEs were related to the transmission of HCV, the use of DAAs, or kidney transplant per se. It appears that the frequency of AEs was greater in those studies where DAAs were not given in the very early post-kidney transplant phase. Conclusions: The evidence gathered to date encourages the expansion of the kidney donor pool with the adoption of HCV-infected donor organs. We suggest that kidney transplants from HCV-viremic kidneys into HCV-uninfected recipients should be made in the context of research protocols. Many of the studies reported above were externally funded and we need research generating “real-world” evidence. The recent availability of pangenotypic combinations of DAAs, which can be given even in patients with eGFR < 30/min/1.73 m2, will promote the notion that HCV-viremic donors are a significant resource for kidney transplant.
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Mathes, David, Scott Stoll Graves, George E. Georges, Christian Kuhr, Jeff Chang, Tiffany Butts, and Rainer Storb. "Long-Term Tolerance to Kidney Allografts After Induced Rejection of Donor Hematopoietic Chimerism in a Preclinical Canine Model." Blood 120, no. 21 (November 16, 2012): 2991. http://dx.doi.org/10.1182/blood.v120.21.2991.2991.
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Abstract Abstract 2991 Allogeneic hematopoietic cell transplantation provides a reliable method for inducing tolerance towards solid organ grafts. However, this procedure can result in graft-versus-host disease (GVHD) thereby limiting its application. Here we test the hypothesis that mixed chimerism can be intentionally reverted to host hematopoiesis without rejection of a kidney graft. Recipient dogs were given 2 Gy total body irradiation (TBI) before and a short course of immunosuppression after marrow infusion from dog leukocyte antigen-identical littermates. All dogs achieved stable mixed chimerism. After a mean of 20 weeks, one cohort of dogs received kidney transplants from their respective marrow donors. Subsequently, recipients were reconditioned with 2 Gy TBI and given autologous granulocyte-colony stimulating factor-mobilized leukocytes (recipient leukocyte infusion) that had been collected before marrow transplant. Dogs receiving a second TBI and recipient leukocyte infusion without a kidney transplant rejected their donor hematopoietic graft within 3 weeks. Dogs that received kidney grafts, followed by a second TBI and recipient leukocyte infusion, rejected their marrow graft without rejecting their transplanted kidneys for periods greater than one year. Mixed chimerism may be clinically reverted to 100% recipient without rejection of a kidney allograft. This model has potential applications in understanding the mechanism of split tolerance. This finding may have application towards minimizing the risk of GVHD in solid organ transplant patients given hematopoietic cell transplantation from HLA-identical donors. Disclosures: No relevant conflicts of interest to declare.
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Hellström, Vivan, Gunnar Tufveson, Angelica Loskog, Mats Bengtsson, Gunilla Enblad, and Tomas Lorant. "Donor-derived urologic cancers after renal transplantation: A retrospective non-randomized scientific analysis." PLOS ONE 17, no. 9 (September 21, 2022): e0271293. http://dx.doi.org/10.1371/journal.pone.0271293.
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Background Malignancies in the urinary tract and the kidney graft are quite common after kidney transplantation. In some selected cases tumours develop from donor-derived tissue. Objectives We hypothesised that there is a clinical value to investigate donor/recipient origin in urologic malignancies in renal transplant recipients. Methods In this retrospective study, including patients transplanted between the years 1969 and 2014 at Uppsala University Hospital, Sweden, 11 patients with malignancies in urinary tract and 4 patients with malignancies in kidney transplants were investigated. Donor/recipient origin of tumour tissue was analysed by polymerase chain reaction (PCR) of human leucocyte antigen (HLA) genotypes or by fluorescence in situ hybridization (FISH analysis) of sex chromosomes. HLA genotype and sex chromosomes of the tumour were compared to the known HLA genotype and sex chromosomes of recipient and donor. Results Three of ten cancers in the urinary tract and three of four cancers in the kidney transplants were donor-derived. Conclusions We suggest that urologic malignancies in renal transplant recipients can be investigated for transplant origin. In addition to conventional therapy the allograft immune response against these tumours can be valuable to treat donor-derived cancers.
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Noya-Mourullo, Andrea, Alejandro Martín-Parada, Alberto Palacios-Hernández, Pablo Eguiluz-Lumbreras, Óscar Heredero-Zorzo, Francisco García-Gómez, José Luis Álvarez-Ossorio-Fernández, et al. "Enhancing Kidney Transplant Outcomes: The Impact of Living Donor Programs." Journal of Personalized Medicine 14, no. 4 (April 12, 2024): 408. http://dx.doi.org/10.3390/jpm14040408.
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Introduction: The protocol for deceased donor kidney transplants has been standardised. The procedure for a living donor has peculiarities derived from the differences in the graft. When a living kidney donor program is implemented, changes occur in both the profile of the kidney transplant candidate and in the postoperative treatments. Aims: To discover whether a living donor program influences the functional outcomes of kidney grafts in a longstanding classical deceased donor kidney transplant program and to identify the factors associated with transplant outcomes. Methods: Retrospective observational multicentre study. Sample: Kidney transplant patients in two urology referral centres for renal transplant in Spain between 1994 and 2019. Groups: TV (living transplant): patients given kidney transplants from living donors (n = 150); TCpre11 (deceased transplant previous to 2011): patients given kidney transplants from deceased donors before the living donor program was implemented (n = 650); and TCpost11 (deceased transplant after 2011): patients given kidney transplants from deceased donors after the living donor program was implemented (n = 500). Results: Mean age was 55.75 years (18–80 years), higher in TCpre11. There were 493 female patients (37.92%) and 1007 male patients (62.08%). Mean body mass index (BMI) was 26.69 kg/m2 (17.50–42.78 kg/m2), higher in TCpre11. Mean ischemia time was 17.97 h (6–29 h), higher in TCpost11. Median duration of urethral catheter: 8 days (6–98 days), higher in TCpost11. Median duration of double-J ureteral stent: 58 days (24–180 days), higher in TCpost11. Pretransplant UTIs: 17.77%, higher in TCpre11 (25.69%) than in TV (12%), higher in TV (12%) than TCpost11 (9.2%), and higher in TCpre11 (25.69%) than TCpost11 (9.2%). Acute renal rejection in 9.33% of TV, 14.77% of TCpre11, and 9.8% of TCpost11. Multivariate analysis: TCpost11 featured higher BMI, more smoking, and chronic renal failure progression time. Lower use of nonantibiotic prophylaxis to prevent recurrent urinary tract infections, increased duration of urethral catheters due to obstructive problems, and favoured deterioration of kidney function was observed in the deceased donor program. The living donor (LD) program had a strong influence on deceased donor transplants in the prelysis phase. Implementation of a LD program was associated with a decrease in the likelihood of acute rejection in TCpost11 and an increase in the tendency towards normal kidney function. Conclusions: Implementing living donor transplant programs affects functional outcomes in deceased donor transplants, reducing the probability of acute rejection and increasing the tendency towards normal kidney function. Preventing recurrent urinary tract infections with measures other than antibiotics, smoking cessation, delaying the removal of the double-J stent from the graft, and pre-emptive transplant (transplant prior to dialysis) are associated with improved renal function of the graft.
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Rapela Heidt, Mari. "We need more kidneys: Living donation, BMI, and Black mortality from renal disease." Review & Expositor 119, no. 1-2 (May 2022): 100–109. http://dx.doi.org/10.1177/00346373221136249.
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Renal disease is an endemic problem within the United States, with about 10% of the population afflicted with kidney problems that range from minor to life-threatening. Black Americans are especially affected by kidney disease, with a high proportion of those affected needing a kidney transplant. While kidney transplants are very common, a shortage of donated kidneys exists, causing many people to turn to directed living donation, through which family members or friends volunteer to donate a healthy kidney to a specific person. This essay examines racial bias in the evaluation of living donors, especially the bias associated with body mass index. The requirement for a “normal weight” prevents many African American volunteers from donating, leading to a higher mortality rate than necessary for Black kidney transplant patients.
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Nugroho, Eriawan Agung, Tommy Supit, Ardy Santosa, Nanda Daniswara, Sofyan Rais Addin, and Anggun Ari Mukti. "Kidney Transplantation in Semarang: Outcomes and Prognosis." Medica Hospitalia : Journal of Clinical Medicine 6, no. 1 (September 20, 2019): 59–63. http://dx.doi.org/10.36408/mhjcm.v6i1.381.
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Introduction & objective:Kidney transplantationis increasingly performed acrossIndonesia, including in Semarang. However there are limited publications onrenal transplantationfrom Indonesia, especially from centers outside Jakarta. The objective of this case series is to give a brief overview on the transplantation performed in Semarang, discusscurrent issues and ongoing efforts to address them.
Case series:Twenty-seven renal transplants in Dr. Kariadi General Hospital from January2012 until July 2018wereretrospectively analyzed. On average recipients were younger (32.5 years old) compared to the donors (46.8 years old). All kidneys were acquired from living donors with the majority of them to be blood-related(74.1%). The 3 leading etiologies of end-stage renal disease were hypertension (36.0%), diabetes mellitus (26.9%), and autoimmune disease (11.2%). The average total ischemic time was 36.9 minutes andthe average length of stay was 11 days. We report 5 cases of mortality, 3 cases of allograft rejection and no re-transplantation.
Discussion: The demographics of kidney transplant patients in Semarang were similar compared to the National data. The limited number of transplant in Semarang contributes to the low number of survival rate and highlights the need of further training and expertise. Better survival rate can be achieved with more transplants number as well as reaching the plateau of learning curve within the coming years.
Conclusion: The development of kidney transplant in Semarang follows the National milestones. In order to maximize the potentialthe institution, further improvements should concentrate on the development of integrated organ transplant infrastructure. The main goal of this institution is to establish a solid transplant center capable of covering Central Java, aiding the decentralization of kidney transplant in the Nation
Keywords: Kidney transplantation, End-stage Renal Disease, Chronic Kidney Disease, Indonesia, Semarang, Epidemiology, Update
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Fairchild, Robert L., Satoshi Miyairi, Nina Dvorina, Anna Valujskikh, and William M. Baldwin. "Kidney Allograft Recipient Absence of Myeloperoxidase Decreases Donor-Specific Antibody Titers and Attenuates Antibody-Mediated Allograft Rejection." Journal of Immunology 202, no. 1_Supplement (May 1, 2019): 69.14. http://dx.doi.org/10.4049/jimmunol.202.supp.69.14.
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Abstract The incidence of antibody-mediated rejection (AMR) in clinical kidney transplants is increasingly observed. We have reported that strong donor-specific antibody (DSA) responses are induced in B6.CCR5−/−mice transplanted with complete MHC mismatched A/J kidney allografts and that NK cells play a critical role in acute injury and graft failure. Since this acute AMR is accompanied by intense macrophage infiltration into the allograft, we tested the role of recipient-derived myeloperoxidase (MPO) production on kidney allograft survival. B6.CCR5−/−and B6.CCR5−/−MPO−/−mice were transplanted with complete MHC mismatched A/J kidney grafts. Allografts were rejected between days 18 and 25 post-transplant in B6.CCR5−/−recipients but not until days 46–54 in B6.CCR5−/−MPO−/− recipients. DSA titers in B6.CCR5−/−MPO−/−recipients were 4–5 fold lower than those induced in the B6.CCR5−/− recipients. There was also a 60% decrease in the number of donor-reactive T cells producing IFN-g in the spleens of the B6.CCR5−/−MPO−/− vs. B6.CCR5−/−recipients on day 7 post-transplant. Despite the extended survival, qPCR analyses indicated slight increases in mRNA encoding TNFa, IL-6 and FasL in kidney allografts on day 14 post-transplant in B6.CCR5−/−MPO−/− vs. B6.CCR5−/−recipients as well as the pro-fibrogenic factors P-selectin and connective tissue growth factor on day 50 post-transplant. These results suggest MPO regulates the magnitude of the DSA and T cell response in kidney transplant recipients and that the decreased DSA titers attenuate acute AMR but induce the indolent development of interstitial fibrosis and glomerular injury that will eventually lead to graft dysfunction and failure at later times.
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Leeser, David B., Alvin G. Thomas, Ashton A. Shaffer, Jeffrey L. Veale, Allan B. Massie, Matthew Cooper, Sandip Kapur, et al. "Patient and Kidney Allograft Survival with National Kidney Paired Donation." Clinical Journal of the American Society of Nephrology 15, no. 2 (January 28, 2020): 228–37. http://dx.doi.org/10.2215/cjn.06660619.
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Background and objectivesIn 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, & measurementsUsing 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).ResultsNational 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.ConclusionsEven 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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Thongprayoon, Charat, Caroline C. Jadlowiec, Wisit Kaewput, Pradeep Vaitla, Shennen A. Mao, Michael A. Mao, Napat Leeaphorn, et al. "Distinct Phenotypes of Kidney Transplant Recipients in the United States with Limited Functional Status as Identified through Machine Learning Consensus Clustering." Journal of Personalized Medicine 12, no. 6 (May 25, 2022): 859. http://dx.doi.org/10.3390/jpm12060859.
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Background: There have been concerns regarding increased perioperative mortality, length of hospital stay, and rates of graft loss in kidney transplant recipients with functional limitations. The application of machine learning consensus clustering approach may provide a novel understanding of unique phenotypes of functionally limited kidney transplant recipients with distinct outcomes in order to identify strategies to improve outcomes. Methods: Consensus cluster analysis was performed based on recipient-, donor-, and transplant-related characteristics in 3205 functionally limited kidney transplant recipients (Karnofsky Performance Scale (KPS) < 40% at transplant) in the OPTN/UNOS database from 2010 to 2019. Each cluster’s key characteristics were identified using the standardized mean difference. Posttransplant outcomes, including death-censored graft failure, patient death, and acute allograft rejection were compared among the clusters Results: Consensus cluster analysis identified two distinct clusters that best represented the clinical characteristics of kidney transplant recipients with limited functional status prior to transplant. Cluster 1 patients were older in age and were more likely to receive deceased donor kidney transplant with a higher number of HLA mismatches. In contrast, cluster 2 patients were younger, had shorter dialysis duration, were more likely to be retransplants, and were more likely to receive living donor kidney transplants from HLA mismatched donors. As such, cluster 2 recipients had a higher PRA, less cold ischemia time, and lower proportion of machine-perfused kidneys. Despite having a low KPS, 5-year patient survival was 79.1 and 83.9% for clusters 1 and 2; 5-year death-censored graft survival was 86.9 and 91.9%. Cluster 1 had lower death-censored graft survival and patient survival but higher acute rejection, compared to cluster 2. Conclusion: Our study used an unsupervised machine learning approach to characterize kidney transplant recipients with limited functional status into two clinically distinct clusters with differing posttransplant outcomes.
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Nasr, Dayana, Mahmoudreza Moein, Stephanie Niforatos, Sandy Nasr, Mulham Ombada, Farzam Khokhar, Myera Shahnawaz, et al. "Piperacillin/Tazobactam and Meropenem Use Increases the Risks for Acute Graft Rejection Following First Kidney Transplantation." Journal of Clinical Medicine 11, no. 10 (May 11, 2022): 2726. http://dx.doi.org/10.3390/jcm11102726.
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Many broad-spectrum antibiotics (BSA) alter the intestinal microbiome that regulates adaptive immune responses. We hypothesized that BSA use before and early after kidney transplant may affect acute graft rejection (AGR). We carried out a retrospective cohort study on all patients who underwent kidney transplants in our institution. Patient demographics, clinical data, diagnosis, and treatment history were collected. Antibiotic use within 2 months prior to transplant and during the hospital admissions for transplant, as well as antibiotic types were recorded. A total of 357 consecutive first transplants were included for analysis. Median age was 52 years (range 7–76). A total of 67 patients received living donor and 290 deceased donor kidneys. A total of 19 patients received BSA within two months prior to transplant and 55 patients during the hospital admission for the transplant. With a median follow-up of 1270 days, 38 episodes of biopsy-proven AGR were recorded. There was no difference in the AGR rates during the first year between patients who received BSA and those who did not. However, the use of piperacillin/tazobactam or meropenem (PM) was associated with increased risks for the development of AGR, irrespective of the source of the donor grafts. Time to development of AGR was also shorter. Our data, therefore, suggest that the use of PM BSA prior to and immediately after kidney transplant increases the risks for AGR.
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Dreher, Paulette Cutruzzula, Jessica M. Fazendin, Kelly Lurz, Daniel C. Edwards, Stephen Guy, and Melanie Amster. "Painful angiomyxoid tumor in a failed renal allograft presenting as post-transplant lymphoproliferative disorder." Journal of Nephropathology 9, no. 2 (September 10, 2019): e20-e20. http://dx.doi.org/10.34172/jnp.2020.20.
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Introduction: There exist few reports of de novo tumors involving an allograft kidney, and to the best of our knowledge there are only two previous reports of angiomyxoma Case Presentation: A 53-year-old Caucasian male with end-stage renal disease (ESRD) on hemodialysis (HD) secondary to malakoplakia with three failed prior renal transplants presented for repeat transplant evaluation. Imaging demonstrated a mass of the transplanted kidney suggestive of posttransplant lymphoproliferative disease (PTLPD). A biopsy was obtained revealing a predominance of myxoid material. The patient became increasingly symptomatic from the mass and underwent a palliative right transplant nephrectomy. Final pathology revealed angiomyxoid tumor. Conclusions: Angiomyxomas are asymptomatic, appear as PTLD on imaging and should be considered in the differential diagnosis of masses occurring in renal transplant allografts.
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Valecha, Jayesh, Vasu Gupta, Vaidehi Mendpara, Carson Eric Snyder, Fnu Anamika, Kinna Parikh, Talha Mahmood, Shreya Garg, and Rohit Jain. "COVID-19 in Renal Transplant Patients – A Narrative Review." Nigerian Journal of Medicine 32, no. 3 (2023): 235–38. http://dx.doi.org/10.4103/njm.njm_23_23.
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Abstract The World Health Organisation declared the novel coronavirus known as severe acute respiratory syndrome coronavirus 2 a pandemic in March 2020. This virus has led to the deaths of more than 6 million people worldwide. Besides causing pneumonia, COVID-19 is linked to multiple organ dysfunction, including the kidneys, especially in individuals whose immune systems are already compromised. Consequently, individuals who are currently on a waiting list for a kidney transplant or who have recently received a kidney transplant are at a significantly increased risk for developing acute kidney injury and are severely impacted by the COVID-19 infection. The pandemic has negatively affected the transplantation process and led to a decrease in the number of organ donations as well as the volume of renal transplants. This review summarises the outcomes of COVID-19 infection in renal transplant patients, its pathophysiology, the challenges faced by the transplant community, and the management of immunosuppression.
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Tenenbaum, Evelyn M. "Bartering for a Compatible Kidney Using Your Incompatible, Live Kidney Donor: Legal and Ethical Issues Related to Kidney Chains." American Journal of Law & Medicine 42, no. 1 (March 2016): 129–69. http://dx.doi.org/10.1177/0098858816644719.
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Kidney chains are a recent and novel method of increasing the number of available kidneys for transplantation and have the potential to save thousands of lives. However, because they are novel, kidney chains do not fit neatly within existing legal and ethical frameworks, raising potential barriers to their full implementation.Kidney chains are an extension of paired kidney donation, which began in the United States in 2000. Paired kidney donations allow kidney patients with willing, but incompatible, donors to swap donors to increase the number of donor/recipient pairs and consequently, the number of transplants. More recently, transplant centers have been using non-simultaneous, extended, altruistic donor (“NEAD”) kidney chains—which consist of a sequence of donations by incompatible donors—to further expand the number of donations. This Article fully explains paired kidney donation and kidney chains and focuses on whether NEAD chains are more coercive than traditional kidney donation to a family member or close friend and whether NEAD chains violate the National Organ Transplant Act's prohibition on the transfer of organs for valuable consideration.