Influence of Deceased Donor and Pretransplant Recipient Parameters on Early Overall Kidney Graft-Survival in Germany

Abstract

Background. Scarcity of grafts for kidney transplantation (KTX) caused an increased consideration of deceased donors with substantial risk factors. There is no agreement on which ones are detrimental for overall graft-survival. Therefore, we investigated in a nationwide multicentre study the impact of donor and recipient related risks known before KTX on graft-survival based on the original data used for allocation and graft acceptance. Methods. A nationwide deidentified multicenter study-database was created of data concerning kidneys donated and transplanted in Germany between 2006 and 2008 as provided by the national organ procurement organization (Deutsche Stiftung Organtransplantation) and BQS Institute. Multiple Cox regression (significance level 5%, hazard ratio [95% CI]) was conducted (n = 4411, isolated KTX). Results. Risk factors associated with graft-survival were donor age (1.020 [1.013–1.027] per year), donor size (0.985 [0.977–0.993] per cm), donor's creatinine at admission (1.002 [1.001–1.004] per µmol/L), donor treatment with catecholamine (0.757 [0.635–0.901]), and reduced graft-quality at procurement (1.549 [1.217–1.973]), as well as recipient age (1.012 [1.003–1.021] per year), actual panel reactive antibodies (1.007 [1.002–1.011] per percent), retransplantation (1.850 [1.484–2.306]), recipient's cardiovascular comorbidity (1.436 [1.212–1.701]), and use of IL2-receptor antibodies for induction (0.741 [0.619–0.887]). Conclusion. Some donor characteristics persist to impact graft-survival (e.g., age) while the effect of others could be mitigated by elaborate donor-recipient match and care.

Dopamine in transplantation: Written off or comeback with novel indication?

“…More recently, a nationwide multicenter survey from Germany exploring deceased donor parameters on graft survival in 4411 kidney transplants between 2006 and 2008 reaffirmed the 1993 cohort study. Multivariable Cox regression resulted in a reduced hazard ratio of 3‐year kidney graft failure, which was 0.757 (95% confidence interval, 0.635‐0.901), when the DBD had received adrenergic agents in the ICU before procurement …”

Organ Dysfunction and Failure Following Brain Death Do Not Preclude Successful Donation

“…Several donor risk factors associated with negative outcomes in recipients have been described extensively in the literature. In kidney, heart and liver transplant recipients, donor age and prolonged cold ischemia time were found to be associated with reduced patient and graft survival [21][22][23]. The correlation with donor age has been thought to be due to the higher incidence of comorbidities often associated with aging such as arterial hypertension, arteriosclerosis and diabetes [21].…”

“…In liver recipients, arterial hypertension and smoking were found to have a significant association with decreased patient and graft survival [22]. However, in these studies no distinction is made between DNDD and DCDD rather they make comparisons between non-traumatic and traumatic causes of death [21][22][23]. Dubbeld et al [24] demonstrated that in NDD liver donors, warm ischemic times, donor age, severe head trauma were associated with increased risk of graft loss within 1 year of transplantation.…”

Cold but not too cold: advances in hypothermic and normothermic organ perfusion

“…In many countries, these are the only categories of donors with increasing numbers, as the numbers of standard criteria donors (SCD) and living donors (LD) are stabilizing or even decreasing. Of course, when using organs from ECD and DCD, the risk of developing IRI is elevated [ 22 ]. This issue has prompted a renewed discussion on how to avoid IRI by using pump machines or supplying nutrients or oxygen.…”