A Risk Index for Living Donor Kidney Transplantation

Massie, Allan B.; Leanza, Joseph; Fahmy, Lara M.; Chow, Eugene M.; Desai, Niraj M.; Luo, Xiaobin; King, Elizabeth A.; Bowring, Mary G.; Segev, Dorry L.

doi:10.1111/ajt.13709

Cited by 118 publications

(132 citation statements)

References 30 publications

(35 reference statements)

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“…The recipient and donor age were fitted using splines as described above. The C-statistic for the 5-year model is 0.64, which compares favorably with other models for graft survival (2,28,29). It should be noted that the C-statistic estimates the probability that the model would allow us to correctly predict which of two randomly chosen individuals would fail first.…”

Section: Using Estimates To Assess and Compare Donor-recipient Outcomesmentioning

confidence: 79%

A Kidney Graft Survival Calculator that Accounts for Mismatches in Age, Sex, HLA, and Body Size

Ashby

Leichtman

Rees

et al. 2017

CJASN

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Background and objectives Outcomes for transplants from living unrelated donors are of particular interest in kidney paired donation (KPD) programs where exchanges can be arranged between incompatible donor-recipient pairs or chains created from nondirected/altruistic donors.Design, setting, participants, & measurements Using Scientific Registry of Transplant Recipients data, we analyzed 232,705 recipients of kidney-alone transplants from 1998 to 2012. Graft failure rates were estimated using Cox models for recipients of kidney transplants from living unrelated, living related, and deceased donors. Models were adjusted for year of transplant and donor and recipient characteristics, with particular attention to mismatches in age, sex, human leukocyte antigens (HLA), body size, and weight.Results The dependence of graft failure on increasing donor age was less pronounced for living-donor than for deceased-donor transplants. Male donor-to-male recipient transplants had lower graft failure, particularly better than female to male (5%-13% lower risk). HLA mismatch was important in all donor types. Obesity of both the recipient (8%-18% higher risk) and donor (5%-11% higher risk) was associated with higher graft loss, as were donor-recipient weight ratios of ,75%, compared with transplants where both parties were of similar weight (9%-12% higher risk). These models are used to create a calculator of estimated graft survival for living donors.Conclusions This calculator provides useful information to donors, candidates, and physicians of estimated outcomes and potentially in allowing candidates to choose among several living donors. It may also help inform candidates with compatible donors on the advisability of joining a KPD program.

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Section: Using Estimates To Assess and Compare Donor-recipient Outcomesmentioning

confidence: 79%

A Kidney Graft Survival Calculator that Accounts for Mismatches in Age, Sex, HLA, and Body Size

Ashby

Leichtman

Rees

et al. 2017

CJASN

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“…Though evidence exists for deceased donor graft longevity, less has been published for living donors. 2,10,11 Brennan et al 12 looked at over 8500 LDKTs calculating a suboptimal graft function score equating worse outcome with recipient serum creatinine 1.5 mg/dL or greater at 1 year. Aside from this being a crude measure of graft longevity, it does not provide concrete information how many added years of function 1 donor provides over another.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, a LDKT risk index was published where it was concluded that donor age, body mass index, race, cigarette use, and HLA B and DR mismatches were associated with risk of graft loss. 2 We identified some similar factors using KLYs.…”

Section: Discussionmentioning

confidence: 99%

HLA Matching Trumps Donor Age: Donor-Recipient Pairing Characteristics That Impact Long-Term Success in Living Donor Kidney Transplantation in the Era of Paired Kidney Exchange

Milner

Melcher

Lee

et al. 2016

Transplantation Direct

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BackgroundWe sought to identify donor characteristics influencing long-term graft survival, expressed by a novel measure, kidney life years (KLYs), in living donor kidney transplantation (LDKT).MethodsCox and multiple regression analyses were applied to data from the Scientific Registry for Transplant Research from 1987 to 2015. Dependent variable was KLYs.ResultsLiving donor kidney transplantation (129 273) were performed from 1987 to 2013 in the United States. To allow sufficient time to assess long-term results, outcomes of LDKTs between 1987 and 2001 were analyzed. After excluding cases where a patient died with a functioning graft (8301) or those missing HLA data (9), 40 371 cases were analyzed. Of 18 independent variables, the focus became the 4 variables that were the most statistically and clinically significant in that they are potentially modifiable in donor selection (P <0.0001; ie, HLA match points, donor sex, donor biological sibling and donor age). HLA match points had the strongest relationship with KLYs, was associated with the greatest tendency toward graft longevity on Cox regression, and had the largest increase in KLYs (2.0 year increase per 50 antigen Match Points) based on multiple regression.ConclusionsIn cases when a patient has multiple potential donors, such as through paired exchange, graft life might be extended when a donor with favorable matching characteristics is selected.

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“…This is because of risks to both the recipient and the donor. Elevated donor BMI is associated with an increased risk of allcause graft loss [34]. Additionally, recipients of transplants from obese donors are more likely to experience DGF [35].…”

Section: Transplantation With An Obese Live Donor Kidneymentioning

confidence: 99%

Bariatric surgery for obese live kidney donors: an analysis of risks and benefits

Brooks¹,

Mitro²,

DeLeonibus³

et al. 2017

Integr Obesity Diabetes

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Background: Obesity can be a barrier to live donor selection and there are reports of obese live kidney donors (OLKDs) undergoing bariatric surgery prior to donation. While this practice has potential promise, the risks associated with it are unclear. Thus, our aim was to evaluate the advantages and disadvantages of this practice.Design: Risks and benefits were ascertained from the literature. Analysis of costs and benefits was performed to provide objective data for each scenario.Results: Live kidney donation is associated with superior outcomes compared to deceased donation. However, live donors are at risk of complications that could be exacerbated by obesity. Higher donor body mass index (BMI) has been associated with inferior recipient outcomes. Bariatric surgery (BS) results in decreased mortality and can induce sustained weight loss. Our cost-benefit analysis revealed a benefit-to-cost ratio of 3.64 for BS prior to live donation by OLKDs. We found ratios of 3.19 and 0.97 for live donation with an obese donor and a deceased donor, respectively. Conclusions:Our results suggest that BS for an OLKD has the potential to increase the number of live donors and improve outcomes. However, more data is required; thus we recommend a registry of patients who have undergone both procedures.

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A Risk Index for Living Donor Kidney Transplantation

Cited by 118 publications

References 30 publications

A Kidney Graft Survival Calculator that Accounts for Mismatches in Age, Sex, HLA, and Body Size

A Kidney Graft Survival Calculator that Accounts for Mismatches in Age, Sex, HLA, and Body Size

HLA Matching Trumps Donor Age: Donor-Recipient Pairing Characteristics That Impact Long-Term Success in Living Donor Kidney Transplantation in the Era of Paired Kidney Exchange

Bariatric surgery for obese live kidney donors: an analysis of risks and benefits

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