Identification of the Optimal Donor Quality Scoring System and Measure of Early Renal Function in Kidney Transplantation

Moore, Jason H.; Ramakrishna, Satish; Tan, Kay; Cockwell, Paul; Eardley, Kevin S.; Little, Mark A.; Rylance, Paul; Shivakumar, K. P.; Suresh, V.; Tomlinson, K.; Ready, Andrew; Borrows, Richard

doi:10.1097/tp.0b013e3181949e71

Cited by 35 publications

(26 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As previously mentioned by our group (12), however, a significant caveat relating to this approach concerned the higher incidence of surgical complications in the authors' series. Composite scoring systems based on the donor kidney's clinical parameters have been described (13,14), but Moore et al (15) showed that the predictive power of these tools was low, or moderate at best. A recent retrospective review by Anglicheau et al (16) showed that a combined clinical and histological pre-transplant assessment had a better predictive power than when only clinical aspects were considered, and the authors underscored the importance of biopsyguided allocation systems.…”

Section: Discussionmentioning

confidence: 99%

A single‐center experience with 200 dual kidney transplantations

Rigotti

Capovilla

Bella

et al. 2014

Clinical Transplantation

View full text Add to dashboard Cite

This study reports on a large series of 200 dual kidney transplantations (DKTs) from expanded criteria donors (ECDs) and proposes specific ways to optimize outcomes. Data concerning 200 DKTs performed in the last 14 yr were retrospectively analyzed. Kidneys from high-risk ECD were allocated for use in DKTs on an old-for-old basis after histological assessment. Different surgical techniques and immunosuppressant regimens were used over time, and the outcomes are discussed. Donors and recipients were a median 73 (70-77) and a 62 (58-67) yr old, respectively. Delayed graft function occurred in 31.5% of cases, and acute rejection in 13.5%. Patient and graft survival at five yr were 90.4% and 85.8%, respectively. Unilateral kidney placement was preferred for 75% of patients, and was associated with a low rate of surgical complications. Our current standard therapy comprising low-dose calcineurin inhibitors (CNIs) associated with mammalian target of rapamycin inhibitors (mTOR) and steroids appears to offer the best risk/benefit profile for elderly patients undergoing DKT. In our experience, outcomes after DKT can be improved by: (i) kidney clinical-histological assessment; (ii) unilateral kidney placement; (iii) minimal use of CNI associated with mTOR.

show abstract

Section: Discussionmentioning

confidence: 99%

A single‐center experience with 200 dual kidney transplantations

Rigotti

Capovilla

Bella

et al. 2014

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…1,2 In renal transplantation, there has been substantial work done on donor risk indices for prediction of graft function after transplantation. [3][4][5][6][7][8] Donor risk scores can aid in organ selection, have policy implications regarding allocation, assist in recipient prognosis, and serve as tools for future research. Currently, no such donorspecific scoring system exists for OHT.…”

mentioning

confidence: 99%

Development of a quantitative donor risk index to predict short-term mortality in orthotopic heart transplantation

Weiss

Allen

Kilic

et al. 2012

The Journal of Heart and Lung Transplantation

145

129

View full text Add to dashboard Cite

“…Trials of the mid and late 1980s evaluated weaning CNIs months or years following transplantation. 7 However, kidney function in the early period post transplantation is a potent determinant of subsequent graft outcome, 8 and, therefore, later studies focused on reducing or completely eliminating CNIs from the time of transplantation itself, a strategy made possible with the development of "non-nephrotoxic" immunosuppressants.…”

mentioning

confidence: 99%

Meta-Analysis of Calcineurin-Inhibitor-Sparing Regimens in Kidney Transplantation

Sharif

Shabir

Chand

et al. 2011

Journal of the American Society of Nephrology

Self Cite

126

View full text Add to dashboard Cite

Calcineurin-inhibitor-sparing strategies in kidney transplantation may spare patients the adverse effects of these drugs, but the efficacy of these strategies is unknown. Here, we conduct a meta-analysis to assess outcomes associated with reducing calcineurin inhibitor exposure from the time of transplantation. We search Medline, Embase, and Cochrane Register of Controlled Trials for randomized controlled trials published between 1966 and 2010 that compared de novo calcineurin-inhibitor-sparing regimens to calcineurin-inhibitor-based regimens. In this analysis, we include 56 studies comprising data from 11337 renal transplant recipients. Use of the contemporary agents belatacept or tofacitinib, in combination with mycophenolate, decreased the odds of overall graft failure (OR 0.61; 95% CI 0.39 -0.96; P ϭ 0.03). Similarly, minimization of calcineurin inhibitors in combination with various induction and adjunctive agents reduces the odds of graft failure (OR 0.73; 95% CI 0.58 -0.92; P ϭ 0.009). Conversely, the use of inhibitors of mammalian target of rapamycin (mTOR), in combination with mycophenolate, increases the odds of graft failure (OR 1.43; 95% CI 1.08 -1.90; P ϭ 0.01). Calcineurin-inhibitor-sparing strategies are associated with less delayed graft function (OR 0.89; 95% CI 0.80 -0.98; P ϭ 0.02), improved graft function, and less new-onset diabetes. The more contemporary protocols did not seem to increase rates of acute rejection. In conclusion, this meta-analysis suggests that reducing exposure to calcineurin inhibitors immediately after kidney transplantation may improve clinical outcomes.

show abstract

Identification of the Optimal Donor Quality Scoring System and Measure of Early Renal Function in Kidney Transplantation

Abstract: This study validates and identifies the optimal early predictive parameter available for kidney transplant recipients, with implications for refining early postoperative management and potential utility in organ allocation policy.

Cited by 35 publications

References 25 publications

A single‐center experience with 200 dual kidney transplantations

A single‐center experience with 200 dual kidney transplantations

Development of a quantitative donor risk index to predict short-term mortality in orthotopic heart transplantation

Meta-Analysis of Calcineurin-Inhibitor-Sparing Regimens in Kidney Transplantation

Contact Info

Product

Resources

About