How good is a living donor? Systematic review and meta-analysis of the effect of donor demographics on post kidney transplant outcomes

Bellini, Maria Irene; Nozdrin, Mikhail; Pengel, Liset; Knight, Simon; Papalois, Vassilios

doi:10.1007/s40620-021-01231-7

Cited by 14 publications

(17 citation statements)

References 55 publications

(83 reference statements)

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“…Another factor considered was BMI, which is a conditioning factor for the recovery of renal function, the importance of which lies in the risk of obesity to develop proteinuria and CKD [16,17] . It has been generally agreed on using BMI to evaluate obesity and in any case exclude from donation candidates with a BMI > 35 kg/m 2 , although due to the shortage of donors, some places have agreed to broaden the selection criteria for living donor candidates, without accepting any de nitive limit [16,18] .…”

Section: Discussionmentioning

confidence: 99%

Evolution of renal function in living renal donors, five-year follow-up of patients operated in the same institution

Medina-Toscano,

González-Espinosa,

González-Ojeda

et al. 2024

Preprint

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Introduction: Chronic kidney disease (CKD) has become a pathology with an increase in its prevalence during the last years. Renal transplantation offers a greater survival advantage for patients with end-stage renal disease. Main long-term conditions for kidney donors, as well as their renal function and the development of renal failure is yet to be studied. Methods: Cross-sectional, analytical study from January 1, 2005 to December 31, 2012 of living renal donors who participated in the renal transplant program of the Centro Médico Nacional de Occidente of the Instituto Mexicano del Seguro Social who were > 18 years of age and who complied with follow-up for 5 years. Results: 302 living donor nephrectomies were performed, a total of 78 patients were included. The estimated mean baseline glomerular filtration rate (GFR) measured in 24-hour urine prior to donation was 120.7 ± 25.82 ml/min/1.73m2, showing a considerable decrease in the first 3 months with an average of 77.9 ± 17.58 ml/min/1.73m2 which represents a decrease of 35.4% with respect to baseline. Conclusions: There is a significant decrease in renal function in living donors during the first months after nephrectomy, but this improves with evolution, although without returning to pre-donation levels.

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Section: Discussionmentioning

confidence: 99%

Evolution of renal function in living renal donors, five-year follow-up of patients operated in the same institution

Medina-Toscano,

González-Espinosa,

González-Ojeda

et al. 2024

Preprint

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“…An interesting finding of our analysis is that donor age, and not donor type, affects the incidence of graft loss. Previous work reports that recipients of grafts from live donors aged < 60 have a 38% lower risk of developing acute rejection compared to those aged > 60 years ( 33 ). Since recipients of older grafts are generally also older in age, this leaves to the open debate on immunosuppression in the elderly, in whom, although physiological immunosenescence linked to biological aging is known, other potential contributors, such as the engraftment of older organs, is associated with higher rejection rates, and thus the need for tailored, age-adopted immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Body mass index affects kidney transplant outcomes: A cohort study over 5 years using a steroid sparing protocol

Bellini

Deurloo²,

Consorti³

et al. 2023

Front. Endocrinol.

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BackgroundThere is controversy regarding the suitability of high body mass index (BMI) candidates accessing the transplant waitlist.Patients and methodsObservational study on consecutive kidney transplant recipients undergoing surgery between January 2014 and March 2016 at our center. Patients were stratified according to BMI. Survival outcomes and graft function were analyzed to investigate the effect of donor’s and recipient’s demographic characteristics.Results396 kidney transplant recipients: 260 males, mean age 51.8 ± 15.9 years, followed up for a mean time of 5.86 ± 2.29 years. Mean BMI 26.2 ± 5.1. BMI class 1 (20 ≤ BMI ≤ 24.9) n=133, class 2 (25 ≤ BMI ≤ 29.9) n= 155, class 3 (30 ≤ BMI ≤34.9) n=53, class 4 (BMI ≥ 35) n=21, class V (BMI ≤ 19.9) n=34. Patient survival was not significantly different according to the recipient’s BMI class (p=0.476); graft survival was affected (p=0.031), as well as graft function up to 2 years post-transplant and at 4 years follow up (p=0.016). At logistic regression the factors independently associated with graft loss were only donor’s age (p=0.05) and BMI class of the recipient (p=0.002).ConclusionsObesity did not impact on patient’s survival but affected graft function and graft loss.

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“…Several studies have focused on comparing the outcomes between LRD and LURD transplant recipients. Most studies have shown similar graft survival between recipients of these two types of living donation (5)(6)(7)(8)(9)(10)(11), while some studies have shown a better survival of LRD recipients compared to LURD recipients (12,13). A recent study with 14 370 patients reported similar patient and overall graft survival in LRD and LURD recipients, while a higher death censored graft failure in LURD recipients was noticeable (14).…”

Section: Introductionmentioning

confidence: 99%

Unrelated versus related living-donor kidney transplantation is associated with higher acute rejection rate but similar graft survival Running title: Outcomes in living-donor kidney transplantation

Pereira¹

2022

TPR

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Kidney transplantation (KT) from living donors has been shown to have multiple benefits compared with that from deceased donors. We sought to compare significant graft outcomes, namely acute rejection (AR), graft function, and survival, between transplant recipients who received a kidney from a living-related donor (LRD) and from a living unrelated donor (LURD). Our cohort comprised 198 donor and recipient pairs undergoing living-donor KT at our center over 10 years. LRD recipients were compared with LURD recipients according to demographic and clinical characteristics, transplant variables (including immunosuppression), graft function, survival, and AR rate. The estimated glomerular filtration rate (eGFR) was similar in both groups over the follow-up time, of 60-65 mL/min (p<0.05 over a 10-year period). Censored graft survival was similar between LRD and LURD recipients (96.9% vs. 98.0% at 5 years and 87.8% vs. 79.4% at 10 years, respectively; p=0.837). LURD recipients had a higher incidence of AR, although LURD recipient status was not an independent risk factor for AR. Multivariate analysis showed that human leukocyte antigen (HLA) -DR mismatch (MM) was an independent predictor of AR (hazard ratio [HR] 2.256, p<0.05). HLA-A and HLA-B MM did not affect the AR HR between the groups. Graft function and censored-death survival rates were similar between the LURD and LRD KT recipients. HLA-DR MM was an independent risk factor for AR.

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How good is a living donor? Systematic review and meta-analysis of the effect of donor demographics on post kidney transplant outcomes

Cited by 14 publications

References 55 publications

Evolution of renal function in living renal donors, five-year follow-up of patients operated in the same institution

Evolution of renal function in living renal donors, five-year follow-up of patients operated in the same institution

Body mass index affects kidney transplant outcomes: A cohort study over 5 years using a steroid sparing protocol

Unrelated versus related living-donor kidney transplantation is associated with higher acute rejection rate but similar graft survival Running title: Outcomes in living-donor kidney transplantation

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