Is It Safe to Use a Kidney From an Expanded Criteria Donor?

Kim, J.M.; Kim, S.J.; Joh, Jae‐Won; Kwon, Choon Hyuck David; Song, Suk-Won; Shin, Max; Kim, B.N.; Lee, S.-K.

doi:10.1016/j.transproceed.2011.05.040

Cited by 16 publications

(9 citation statements)

References 16 publications

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“…13 According to Kim et al norepinephrine for the hemodynamic management of the donors did not lead to an increase in negative outcome with regard to the recipients’ graft function. 12 Although the amount of norepinephrine at reperfusion was higher in the group with DGF this parameter was not detected as an independent risk factor for DGF in the multivariate analysis. Patients with arterial hypotension were more likely to require an increased amount of fluid resuscitation and/or more vasoactive agents, so that correlations maybe present but not causative for DGF.…”

Section: Discussionmentioning

confidence: 74%

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Modifiable Risk Factors for Delayed Graft Function After Deceased Donor Kidney Transplantation

et al. 2019

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Purpose: Delayed graft function is a major complication after kidney transplantation affecting patients’ long-term outcome. The aim of this study was to identify modifiable risk factors for delayed graft function after deceased donor kidney transplantation. Methods: This is a single-center retrospective cohort study of a university transplantation center. Univariate and multivariate step-wise logistic regression analysis of patient-specific and procedural risk factors were conducted. Results: We analyzed 380 deceased donor kidney transplantation patients between October 30, 2008 and December 30, 2017. The incidence of delayed graft function was 15% (58/380). Among the patient-specific risk factors recipient diabetes (2.8 [1.4-5.9] odds ratio [OR] [95% confidence interval [CI]]), American Society of Anesthesiologist score of 4 (2.7 [1.2-6.5] OR [95% CI]), cold ischemic time >13 hours (2.8 [1.5-5.3] OR [95% CI]) and donor age >55 years (1.9 [1.01-3.6] OR [95% CI]) revealed significance. The significant intraoperative, procedural risk factors included the use of colloids (3.9 [1.4-11.3] OR [95% CI]), albumin (3.0 [1.2-7.5] OR [95% CI]), crystalloids >3000 mL (3.1 [1.2-7.5] OR [95% CI]) and mean arterial pressure <80 mm Hg at the time of reperfusion (2.4 [1.2-4.8] OR [95% CI]). Conclusion: Patients undergoing deceased donor kidney transplantation with a mean arterial pressure >80 mm Hg at the time of transplant reperfusion without requiring excessive fluid therapy in terms of colloids, albumin or crystalloids >3000 mL are less likely to develop delayed graft function.

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Section: Discussionmentioning

confidence: 74%

“…8,11 It is still unclear which catecholamine to prefer. 12 However, a liberal use of intraoperative catecholamine therapy seems to be associated with a poorer outcome. 13 Studies analyzing the intraoperative fluid therapy for kidney transplantation, the amount and quality of fluids used showed inconsistent results.…”

Section: Introductionmentioning

confidence: 99%

Modifiable Risk Factors for Delayed Graft Function After Deceased Donor Kidney Transplantation

et al. 2019

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“…At 1 year, the rate of acute rejection was not statistically different, and at 5 years, the death-censored survival rate was not different (92%, P = 0.884) in both groups (75). Another study conducted by Kim et al, which included 42 ECD and 364 SCD, showed higher serum creatinine level at 12 months in ECD, but the survival rate was similar as compared to SCD (76).…”

Section: Clinical Results In Recipients Of Marginal Kidneysmentioning

confidence: 87%

Transplantation of Marginal Organs: Immunological Aspects and Therapeutic Perspectives in Kidney Transplantation

et al. 2020

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“…Kim and associates evaluated the use of extended criteria donor kidney transplants (n = 42) compared with standard criteria donor kidney transplants (n = 364) at a single center and found a higher rate of 1-year rejection (23.5% vs 15.6%; P = .001). 11 These data suggest that, at baseline, the IBW cohort may have been at an increased risk of rejection compared with the TBW cohort. The tacrolimus-based maintenance immunosuppressive regimen was similar throughout the 1-year follow-up; however, the mean mycophenolate dose was less, although not statistically significant for the IBW cohort at 30 days and at 90 days but was similar at 1 year after transplant (1217 vs 1289 mg at 1 y; P = .7).…”

Section: Discussionmentioning

confidence: 82%

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Vacha

Gommer²,

Rege³

et al. 2016

Exp Clin Transplant

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Objectives: The optimal dose of rabbit antithymocyte globulin induction therapy in kidney transplant recipients with high immunologic risk lacks consensus. The purpose of this study was to evaluate the effect of using ideal body weight rather than total body weight for the weight-based dose calculations in this patient population. Materials and Methods: Data were retrospectively collected on 89 adult patients who received rabbit antithymocyte globulin induction therapy for high immunologic risk kidney transplant. Hospital protocol changed from the use of cumulative rabbit antithymocyte globulin doses of 7.5 mg/kg total body weight to 7.5 mg/kg ideal body weight in 2009. Patients were separated into 2 cohorts based on the amount of rabbit antithymocyte globulin (in mg/kg total body weight) received. Rate of biopsy-proven acute rejection, patient survival, and allograft function were evaluated at 90 days and 1 year after transplant. Cost of induction therapy was also evaluated. Results: Baseline demographics were predominantly similar between the 2 cohorts. No significant difference in maintenance immunosuppression was identified. Rates of biopsy-proven acute rejection at 90 days and 1 year were similar between ideal and total body weight cohorts (4.2% vs 0% at 90 days, P = .5; 8.7% vs 0% at 1 year, P = .13). Patient survival and allograft function were also similar. Median cost of rabbit antithymocyte globulin induction therapy per patient was lower in the ideal body weight cohort, but this difference was not statistically significant ($17 542 vs $19 934; P = .3). Conclusions: Our results suggest that use of ideal body weight for dose calculations of rabbit antithymocyte globulin induction therapy in high immunologic risk kidney transplant recipients at 7.5 mg/kg results in low rates of acute rejection with a safety profile similar to that shown with a total body weight dosage. Use of ideal body weight for lower cumulative doses may still need further evaluation in this patient population.

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Is It Safe to Use a Kidney From an Expanded Criteria Donor?

Cited by 16 publications

References 16 publications

Modifiable Risk Factors for Delayed Graft Function After Deceased Donor Kidney Transplantation

Modifiable Risk Factors for Delayed Graft Function After Deceased Donor Kidney Transplantation

Transplantation of Marginal Organs: Immunological Aspects and Therapeutic Perspectives in Kidney Transplantation

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