Expanding the donor pool to increase renal transplantation

Cohen, Bernard; Smits, Jacqueline M.; Haase, Bernadette; Persijn, G. G.; Vanrenterghem, Yves; Frei, Ulrich

doi:10.1093/ndt/gfh506

Cited by 149 publications

(95 citation statements)

References 21 publications

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“…Kidney transplantation is the preferred intervention for patients with end‐stage renal disease because it improves patient survival and quality of life 1, 2, 3, but the donor organ supply is limited 4, 5, 6. Expansion of the donor pool to include kidneys from older donors and/or donors with health issues (United Network for Organ Sharing [UNOS] expanded criteria donor [ECD] kidneys) has helped address growing demand.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety Outcomes of Extended Criteria Donor Kidneys by Subtype: Subgroup Analysis of BENEFIT-EXT at 7 Years After Transplant

Florman

Becker

Bresnahan

et al. 2017

American Journal of Transplantation

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The phase III Belatacept Evaluation of Nephroprotection and Efficacy as First‐Line Immunosuppression Trial–Extended Criteria Donors Trial (BENEFIT‐EXT) study compared more or less intensive belatacept‐based immunosuppression with cyclosporine (CsA)–based immunosuppression in recipients of extended criteria donor kidneys. In this post hoc analysis, patient outcomes were assessed according to donor kidney subtype. In total, 68.9% of patients received an expanded criteria donor kidney (United Network for Organ Sharing definition), 10.1% received a donation after cardiac death kidney, and 21.0% received a kidney with an anticipated cold ischemic time ≥24 h. Over 7 years, time to death or graft loss was similar between belatacept‐ and CsA‐based immunosuppression, regardless of donor kidney subtype. In all three donor kidney cohorts, estimated mean GFR increased over months 1–84 for belatacept‐based treatment but declined for CsA‐based treatment. The estimated differences in GFR significantly favored each belatacept‐based regimen versus the CsA‐based regimen in the three subgroups (p < 0.0001 for overall treatment effect). No differences in the safety profile of belatacept were observed by donor kidney subtype.

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Section: Introductionmentioning

confidence: 99%

Efficacy and Safety Outcomes of Extended Criteria Donor Kidneys by Subtype: Subgroup Analysis of BENEFIT-EXT at 7 Years After Transplant

Florman

Becker

Bresnahan

et al. 2017

American Journal of Transplantation

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“…Az idősebb vesék ugyanis érzékenyebbek az ischaemiás-reperfúziós károsodásra, ennek következtében gyakrabban lép fel delayed graft function, ami a vesetúlélést is negatívan befolyásolja [13,14]. Az ET Senior Program eddigi eredmé-nyeit megerősíti az a tény, hogy ebben a csoportban a 3 éves grafttúlélés (a beteg halála miatti graftvesztés kizárá-sával) nem különbözött a hagyományos HLA-egyezésen alapuló allokációs rendszerben észlelttől [15].…”

Section: áBra 1-3 éVes Grafttúlélés Az Ecd/scd Illetve Dds-csoportokbanunclassified

Donorszelekciós kritériumok vizsgálata a debreceni veseátültetési programban

et al. 2016

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Bevezetés: A donorszervhiány, a donorok életkorának növekedése és a társbetegségek gyakoribbá válása arra ösztönzi a transzplantálóközpontokat, hogy olyan donorvesék elfogadását is mérlegeljék, amelyeket korábban elutasítottak volna. A donorszelekciós kritériumok segíthetnek ennek eldöntésében. Célkitűzés: A különböző kritériumok hasznosságát illetően nincs egységes álláspont, ezért a szerzők megvizsgálták az expanded criteria donor, a deceased donor score és a kidney donor risk index donorszelekciós kritériumok hatását a posztoperatív vesefunkcióra és grafttúlélésre. Módszer: Ötéves intervallumban 205 donor paramétereinek és 138 veseátültetés kimenetelének retrospektív elemzé-sét végezték el. Eredmények: Az expanded criteria donor rendszer szerint optimálisnak véleményezett donorok negyede a magas kockázatú csoportba került a deceased donor score alapján. A magas kockázatú csoportokban rosszabb volt a műtét utáni graftfunkció. A deceased donor score segítségével tovább lehetett bontani a magas kockázatú csoportot. Az így létrejött legmagasabb kockázatú csoport grafttúlélése és műtét utáni graftműködése elmaradt a többi csoportéhoz képest. Következtetések: A vizsgált pontrendszerek segíthetnek a donorpool biztonságos növelé-sében. Orv. Hetil., 2016, 157(24), 946-955. Kulcsszavak: veseátültetés, kiterjesztett donorkritériumok, kimenetel, marginális donor Analysis of donor scoring systems in a single Hungarian transplant centreIntroduction: To ease organ shortage many transplant centres developed different donor scoring systems, however, a general consensus among clinicians on the use of these systems does not still exist. Aim: The aim of the authors was to analyse the effect of expanded criteria donor, deceased donor score and kidney donor risk index on postoperative kidney function and graft survival. Method: Analysis of the characteristics of 138 kidney transplantations and 205 donors in a retrospective study of a five-year period. Results: There was a trend towards rejecting donors in higher risk groups; 22.7% of standard criteria donors belonged to the high risk group of deceased donor score. Graft function was worse in high risk patients. High risk donors can be divided due to the use of deceased donor score. Patients with the highest risk had worse graft function and survival. Conclusions: With the use of these scoring systems grafts with favourable outcome can be selected more precisely.

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“…For example, among those aged 74 years, receiving a deceased donor transplant was associated with a hazard ratio of mortality of 0.67 (95 % confidence interval 0.53, 0.86) as compared to remaining on dialysis [23]. Use of expanded criteria deceased donors [24,25] as well as more liberal use of older living donors [26] also appear to reduce mortality among older people with kidney failure, as compared to similar patients who remain on the transplant waiting list (Box 2). These latter two strategies are especially appealing for use in developing countries, where growth in the prevalence of older people has been most pronounced.…”

Section: Kidney Transplantation Can Also Benefit Older People With Kimentioning

confidence: 99%

Chronic kidney disease and the aging population

Riella

2014

J Nephrol

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Expanding the donor pool to increase renal transplantation

Cited by 149 publications

References 21 publications

Efficacy and Safety Outcomes of Extended Criteria Donor Kidneys by Subtype: Subgroup Analysis of BENEFIT-EXT at 7 Years After Transplant

Efficacy and Safety Outcomes of Extended Criteria Donor Kidneys by Subtype: Subgroup Analysis of BENEFIT-EXT at 7 Years After Transplant

Donorszelekciós kritériumok vizsgálata a debreceni veseátültetési programban

Chronic kidney disease and the aging population

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