Effect of Donor Factors on Early Graft Survival in Adult Cadaveric Renal Transplantation

Swanson, S. John; Hypolite, Iman O.; Agodoa, Lawrence Y.; Batty, D. Scott; Hshieh, Paul; Cruess, David F.; Kirk, Allan D.; Peters, Thomas G.; Abbott, Kevin C.

doi:10.1034/j.1600-6143.2002.020112.x

Cited by 89 publications

(66 citation statements)

References 45 publications

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“…In contrast to the literature, 33,34 our data show that donor and recipient age do not affect the risk of recipient death and graft loss. Furthermore, we did not observe any effect of other important donorrelated factors, such as time spent in the intensive care unit, severe hypotension, or reversible cardiac arrest and renal function.…”

Section: Discussioncontrasting

confidence: 55%

Long-term Follow-up of Kidney Transplants in a Region of Southern Italy

Napoli¹,

Grimaldi

Cacciatore

et al. 2014

Exp Clin Transplant

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Section: Discussioncontrasting

confidence: 55%

Long-term Follow-up of Kidney Transplants in a Region of Southern Italy

Napoli¹,

Grimaldi

Cacciatore

et al. 2014

Exp Clin Transplant

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“…The importance of donor age has been described in several works 18 and the advantage of age-matching underlined. 19 Our elderly pa- tients, and as a result of our effort to age-match grafts and recipients, had a greater probability of receiving a kidney from a donor older than 60 years. Donor age had little influence on graft survival in the older recipient group and no influence on patient survival.…”

Section: Discussionmentioning

confidence: 99%

Do Elderly Patients Deserve a Kidney Graft?

Nunes

Mota

Parada

et al. 2005

Transplantation Proceedings

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Purpose. Compare renal transplant long-term outcomes among recipients aged 60 years or older with those in younger patients. Patients and methods. We analyzed 103 transplants in recipients above 60 years of age for the influence of key factors related to the graft and patient. The results were compared with 1060 transplant recipients aged 18 to 59 years. Results. The mean ages were 62.93 and 40.35 years for the older and younger group. The older group showed a higher prevalence of obesity and unknown etiologies for the end-stage renal disease. Important comorbidity was significantly more frequent among recipients aged more than 60 years, mainly of a cardiovascular nature (56% vs 18.5%). Donor age (39.75 vs 31.59 years), cold ischemia time (22.43 vs 20.49 hours) and human leukocyte antigen compatibilities (2.59 vs 2.36) were significantly greater in the older subset. After a mean follow-up of 4.72 and 6.07 years for the older versus younger group, we found no differences in initial graft function, acute rejection rate, and serum creatinine/clearance. Patient and graft survivals at 1, 5, and 10 years were lower among the 60ϩ group. There were no differences in graft survival censored for death with a functioning graft, namely, 95.1%, 89.4%, and 81.2% for the 60ϩ cohort. The main cause of graft loss in the older group was death with a functioning graft. Conclusion. Renal transplantation should be considered for selected patients older than 60 years. Despite a shorter life expectancy, they benefit from it similar to younger recipients. T HE INCIDENCE OF end-stage renal disease (ESRD)increases with advancing age. Patients older than 60 years represent between 53% and 66% of the population requiring renal replacement therapies.1 Therapy for ESRD in the elderly is characterized by tremendous challenges, raising medical, ethical, and socioeconomic concerns. Hemodialysis, the most frequently used renal replacement modality in these patients, is associated with significant morbidity, mortality, and a poor quality of life.2,3 The great organ shortage, higher comorbidity rate, and shorter life expectancy make the allocation of kidneys to this population controversial.Nevertheless, transplantation is the gold standard treatment for ESRD patients. With immunosuppression based upon calcineurin inhibitors, it has become a feasible alternative for the elderly population. 4 -7 Compared with hemodialysis, renal transplantation is associated with a 61% decrease in the long-term risk of death and an additional 4-year life expectancy for patients over 60 years. 4 In this retrospective study, we report a single-center, long-term follow-up of kidney transplants in patients above

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“…The data set and analytical techniques have previously been described (4). In summary, the USRDS standard analysis file (SAF) provided the primary file including information at the time of transplantation.…”

Section: Data Sources and Study Samplementioning

confidence: 99%

Hepatitis C and Renal Transplantation in the Era of Modern Immunosuppression

Abbott¹,

Bucci²,

Matsumoto³

et al. 2003

Journal of the American Society of Nephrology

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102

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Abstract. Kidneys from donors who are positive for hepatitis C virus (DHCVϩ) have recently been identified as an independent risk factor for mortality after renal transplantation. However, it has not been determined whether risk persists after adjustment for baseline cardiac comorbidity or applies in the era of modern immunosuppression. Therefore, a historical cohort study was conducted of US adult cadaveric renal transplant recipients from January 1, 1996, to May 31, 2001 followed until October 31, 2001. A total of 36,956 patients had valid donor and recipient HCV serology. Cox regression analysis was used to model adjusted hazard ratios for mortality and graft loss, respectively, adjusted for other factors, including comorbid conditions from Center for Medicare and Medicaid Studies Form 2728 and previous dialysis access-related complications. It was found that DHCVϩ was independently associated with an increased risk of mortality (adjusted hazard ratio, 2.12, 95% confidence interval, 1.72 to 2.87; P Ͻ 0.001), primarily as a result of infection. Mycophenolate mofetil was associated with improved survival in DHCVϩ patients, primarily related to fewer infectious deaths. Adjusted analyses limited to recipients who were HCVϩ, HCV negative, or age 65 and over, or by use of mycophenolate mofetil confirmed that DHCVϩ was independently associated with mortality in each subgroup. It is concluded that DHCVϩ is independently associated with an increased risk of mortality after renal transplantation adjusted for baseline comorbid conditions in all subgroups. Recipients of DHCVϩ organs should be considered at high risk for excessive immunosuppression.The expected clinical course of hepatitis C infection as it affects organ transplant recipients, as well as the use and effect of kidneys from donors who are positive for hepatitis C, remain controversial topics in renal transplantation. Recently published data confirmed that kidneys from donors who were hepatitis C positive (HCVϩ) were associated with an independently increased risk of death in renal transplant recipients regardless of recipient HCV status (1). However, donor hepatitis C seropositivity (DHCVϩ) was not independently associated with mortality when limited to patients with valid information (Centers for Medicare and Medicaid Studies [CMS] Form 2728) on comorbid conditions at the time of dialysis initiation. This may have been because of the relatively small numbers of transplant recipients for whom complete data were available during the study period or because cardiovascular comorbidity was actually lower in patients who received DHCVϩ kidneys, yet the mortality risk for recipients of DHCVϩ kidneys was still greater than for patients who received DHCVϪ kidneys. Possibly, recipients of DHCVϩ kidneys were sicker to start with and thus had a higher risk of death unrelated to receiving a DHCVϩ kidney. Since that study, there have been substantial changes in maintenance immunosuppression practices in the United States. In particular, recent reports have confirmed tha...

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Effect of Donor Factors on Early Graft Survival in Adult Cadaveric Renal Transplantation

Cited by 89 publications

References 45 publications

Long-term Follow-up of Kidney Transplants in a Region of Southern Italy

Long-term Follow-up of Kidney Transplants in a Region of Southern Italy

Do Elderly Patients Deserve a Kidney Graft?

Hepatitis C and Renal Transplantation in the Era of Modern Immunosuppression

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