Donor Factors Predictive for Poor Outcomes of Living Donor Kidney Transplantation

Chen, G.D.; Gu, J.L.; Zhang, X.D.; Qiu, Jiawei; Wang, C.X.; Chen, L.Z.

doi:10.1016/j.transproceed.2012.11.015

Cited by 8 publications

(6 citation statements)

References 8 publications

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“…Replacing mGFR with eGFR CKD-EPI led to similar results. Moreover, the other determinants of recipient GFR were in line with prior studies (6,31), supporting the generalizability of our data. Finally, phosphate transport represents only one of the many tubular processes; other functional tubular markers in donors may also be associated with the recipient GFR.…”

supporting

confidence: 90%

Tubular maximum phosphate reabsorption capacity in living kidney donors is independently associated with one-year recipient GFR

Londen¹,

Aarts²,

Sanders³

et al. 2018

American Journal of Physiology-Renal Physiology

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The donor glomerular filtration rate (GFR) measured before kidney donation is a strong determinant of recipient graft outcome. No tubular function markers have been identified that can similarly be used in donors to predict recipient outcomes. In the present study we investigated whether the pre-donation tubular maximum reabsorption capacity of phosphate (TmP-GFR), which may be considered a functional tubular marker in healthy kidney donors, is associated with recipient GFR at 1 yr after transplantation, a key determinant of long-term outcome. We calculated the pre-donation TmP-GFR from serum and 24-h urine phosphate and creatinine levels in 165 kidney donors, and recipient I-iothalamate GFR and eGFR (CKD-EPI) at 12 mo after transplantation. Kidney donors were 51 ± 10 yr old, 47% were men, and mean GFR was 118 ± 26 ml/min. The donor TmP-GFR was associated with recipient GFR 12 mo after transplantation (GFR 6.0 ml/min lower per 1 mg/dl decrement of TmP-GFR), which persisted after multivariable adjustment for donor age, sex, pre-donation GFR, and blood pressure and other potential confounders. Results were highly similar when eGFR at 12 mo was taken as the outcome. Tubular damage markers kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin were low and not associated with recipient GFR. A lower donor TmP-GFR before donation, which may be considered to represent a functional measure of tubular phosphate reabsorption capacity, is independently associated with a lower recipient GFR 1 yr after transplantation. These data are the first to link donor tubular phosphate reabsorption with recipient GFR post-transplantation.

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supporting

confidence: 90%

Tubular maximum phosphate reabsorption capacity in living kidney donors is independently associated with one-year recipient GFR

Londen¹,

Aarts²,

Sanders³

et al. 2018

American Journal of Physiology-Renal Physiology

View full text Add to dashboard Cite

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“…However, the impact of donor GFR on graft outcome is less clear for living‐donor KT. A recent study from China showed that graft GFR < 35 mL/min before transplantation was an independent risk factor for long‐term graft survival . Interestingly, our results suggested that donor eGFR within normal limit, like 60.0–88.0 mL/min, could be associated with poor graft outcome.…”

Section: Discussionmentioning

confidence: 50%

“…Younger recipient age has also been regarded as a risk factor for higher rejection rate due to stronger immunological milieu . Although it is not clear why male recipients experience a higher risk of acute rejection, poorer outcome has been reported for female donors . In our study, this pattern may be partly due to the higher proportion of female donors for male recipients (51.4%) than for female recipients (41.8%, p = 0.021).…”

Section: Discussionmentioning

confidence: 50%

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Impact of donor kidney function and donor age on poor outcome of living‐unrelated kidney transplantation (KT) in comparison with living‐related KT

Park

Shin

Jang

et al. 2014

Clinical Transplantation

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Living-unrelated donors (LURD) have been widely used for kidney transplantation (KT). We retrospectively reviewed 779 patients who underwent living-donor KT from 2000 to 2012, to compare outcomes of 264 KT from LURD and 515 from living-related donors (LRD), and to identify risk factors for living KT. Median follow-up was 67 months. Mean donor age, total human leukocyte antigen (HLA) mismatches, and HLA-DR mismatches were higher, and mean estimated glomerular filtration rate (eGFR) was lower in LURD. Acute rejection (AR)-free survival (p = 0.018) and graft survival (p = 0.025) were lower for LURD than LRD, whereas patient survival rate was comparable. Cox regression analysis showed HLA-DR mismatches (OR 1.75 for one mismatch; OR 2.19 for two mismatches), recipient age ≤ 42 yr, and donor age > 50 yr were significant risk factors for acute rejection. For graft survival, AR and donor eGFR (OR 1.90, p = 0.035) were significant. We also identified significant impact of recipient age > 50 yr and diabetes for patient survival. However, KT from LURD was not a significant risk factor for AR (p = 0.368), graft survival (p = 0.205), and patient survival (p = 0.836). Our data suggest that donor eGFR and donor age are independent risk factors for clinical outcomes of living KT, which can be related with poor outcome of KT from LURD.

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“…However, death-censored graft survival and recipient survival were not statistically significantly different between donor age groups [38]. While this analysis and others report inferior graft function among recipients of older kidneys [38, 42, 44–46], older donors often have significantly lower baseline GFRs as compared with their younger counterparts prior to donation [42, 44, 45]. This trend calls into question whether it is truly age or reduced renal function that is the donor characteristic most directly responsible for differences in graft function.…”

Section: Medical Complexities At Donation and Associated Outcomesmentioning

confidence: 83%

The Outcomes of Living Kidney Donation from Medically Complex Donors: Implications for the Donor and the Recipient

Niemi

Mandelbrot

2013

Curr Transpl Rep

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Living kidney donation is an important option for patients with end-stage renal disease (ESRD), and has improved life expectancy and quality for patients otherwise requiring maintenance dialysis or deceased-donor transplantation. Given the favorable outcomes of live donation and the shortage of organs to transplant, individuals with potentially unfavorable demographic and clinical characteristics are increasingly being permitted to donate kidneys. While this trend has successfully expanded the live donor pool, it has raised concerns as to which acceptance criteria are safe. This review aims to summarize the existing literature on the outcomes of transplantation from medically complex, living kidney donors, including both donor and recipient outcomes when available.

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Donor Factors Predictive for Poor Outcomes of Living Donor Kidney Transplantation

Cited by 8 publications

References 8 publications

Tubular maximum phosphate reabsorption capacity in living kidney donors is independently associated with one-year recipient GFR

Tubular maximum phosphate reabsorption capacity in living kidney donors is independently associated with one-year recipient GFR

Impact of donor kidney function and donor age on poor outcome of living‐unrelated kidney transplantation (KT) in comparison with living‐related KT

The Outcomes of Living Kidney Donation from Medically Complex Donors: Implications for the Donor and the Recipient

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