Kidney transplantation in older recipients: Preemptive high KDPI kidney <i>vs</i> lower KDPI kidney after varying dialysis vintage

Chopra, Bhavna; Sureshkumar, Kalathil K

doi:10.5500/wjt.v8.i4.102

Cited by 15 publications

(18 citation statements)

References 23 publications

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“…Dialysis duration has been suggested as the strongest independent modifiable risk factor for kidney transplant recipients because of its association with increased comorbidity burden, immunological alterations, and physiological reserve decline in recipients. 5 , 22 Meanwhile, longer hospital stay after transplant has been attributed to the disease status of the recipient and the organ. 6 Prolonged transplant admission, therefore, is likely a reflection of a high-risk recipient who is prone to adverse outcomes such as early readmissions.…”

Section: Discussionmentioning

confidence: 99%

What Are the Burden, Causes, and Costs of Early Hospital Readmissions After Kidney Transplantation?

Famure

Kim

et al. 2021

Prog Transpl

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Introduction: Kidney transplant recipients are at risk for complications resulting in early hospital readmission. This study sought to determine the incidences, risk factors, causes, and financial costs of early readmissions. Design: This single-centre cohort study included 1461 kidney recipients from 1 Jul 2004 to 31 Dec 2012, with at least 1-year follow-up. Early readmission was defined as hospitalization within 30 or 90-days postdischarge from transplant admission. Associations between various parameters and 30 and 90-days posttransplant were determined using multivariable Cox proportional hazards models. The hospital-associated costs of were assessed. Results: The rates of early readmission were 19.4% at 30 days and 26.8% at 90 days posttransplant. Mean cost per 30-day readmission was 11 606 CAD. Infectious complications were the most common reasons and resulted in the greatest cost burden. Factors associated with 30 and 90-days in multivariable models were recipient history of chronic lung disease (hazard ratio or HR 1.78 [95%CI: 1.14, 2.76] and HR 1.68 [1.14, 2.48], respectively), median time on dialysis (HR 1.07 [95% CI: 1.01, 1.13]and HR 1.06 [95% CI: 1.01, 1.11], respectively), being transplanted preemptively (HR 1.75 [95% CI: 1.07, 2.88] and HR 1.66 [95% CI: 1.07, 2.57], respectively), and having a transplant hospitalization lasting of and more than 11 days (HR 1.52 [95% CI: 1.01, 2.27] and HR 1.65 [95% CI: 1.16, 2.34], respectively). Discussion: Early hospital readmission after transplantation was common and costly. Strategies to reduce the burden of early hospital readmissions are needed for all patients.

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Section: Discussionmentioning

confidence: 99%

What Are the Burden, Causes, and Costs of Early Hospital Readmissions After Kidney Transplantation?

Famure

Kim

et al. 2021

Prog Transpl

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“…Tullius et al 27 established that the risk of rejection in allografts from older donors is attenuated in older recipients—a benefit likely afforded through immunosenescence—whereas separate US studies have suggested that preemptive transplantation, in minimizing the accrued morbidity of dialysis, may offset risks associated with high-KDPI allografts in older recipients. 25,28…”

Section: Discussionmentioning

confidence: 99%

“…Beyond specific donor circumstances, these discussions may be moderated by multiple factors, including avoidance of antibodies in sensitized patients, likelihood of future offers, and potential morbidity of remaining on dialysis. 25 …”

Section: Discussionmentioning

confidence: 99%

Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantation

Tully

Hayes

Hughes

et al. 2022

Transplantation Direct

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Kidney TransplantationBackground. The reporting of a locally validated kidney donor profile index (KDPI) began in Australia in 2016. Across diverse populations, KDPI has demonstrated utility in predicting allograft survival and function. A metric that incorporates both elements may provide a more comprehensive picture of suboptimal recipient outcomes. Methods. A retrospective cohort study of adult kidney transplant recipients in Australia (January 2009 to December 2014) was conducted. Conventional recipient outcomes and a composite measure of suboptimal outcome (1-y allograft failure or estimated glomerular filtration rate [eGFR] <30 mL/min) were evaluated across KDPI intervals (KDPI quintiles and 5-point increments in the KDPI 81-100 cohort). The impact of increasing KDPI on allograft function (1-y eGFR) and a suboptimal outcome was explored using multivariable regression models, adjusting for potential confounding factors. Results. In 2923 donor kidneys eligible for analysis, median KDPI was 54 (interquartile range [IQR], 31-77), and Kidney Donor Risk Index was 1.39 (IQR, 1.03-1.67). The median 1-y eGFR was 52.74 mL/min (IQR, 40.79-66.41 mL/min). Compared with the first quintile reference group, progressive reductions in eGFR were observed with increasing KDPI and were maximal in the fifth quintile (adjusted β-coefficient: −27.43 mL/min; 95% confidence interval, -29.44 to -25.42; P < 0.001). A suboptimal outcome was observed in 359 recipients (12.3%). The adjusted odds for this outcome increased across quintiles from a baseline of odds ratio of 1.00 (first quintile) to odds ratio of 11.68 (95% confidence interval, 6.33-21.54, P < 0.001) in the fifth quintile cohort. Conclusions. Increases in donor KDPI were associated with higher probabilities of a suboptimal outcome and poorer baseline allograft function, particularly in the KDPI > 80 cohort. These findings may inform pretransplant discussions with potential recipients of high-KDPI allografts.

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Section: Introductionmentioning

confidence: 99%

“…Preemptive Kidney Transplantation (PKT) is defined as Kidney Transplantation (KT) before starting chronic dialysis [1,2]. Chances of receiving PKT are more likely with the availability of living kidney donors, but only one third of the Living Donor Kidney Transplantations (LDKT) currently receives PKT [1][2][3]. These shortcomings in the progress of PKT could be principally attributed to delayed referral of patients to transplantation centers and a few unfavourable concerns about PKT [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Advantaged Outcomes of Pre-emptive Living Donor Kidney Transplantation and the Effect of Bias

Kabiri

2019

ETUN

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Preemptive living donor kidney transplantation is the optimal treatment of end-stage renal disease with advantaged outcomes when it is compared to transplantation after starting chronic dialysis. However, these advantages are concerned to be affected by the lead-time and patients' selection bias effects. We classified the potential biasing factors into intrinsic and extrinsic factors to the process of kidney transplantation and presented a different perspective in the effect of bias. We considered these factors as mere characteristics in the process of preemptive living donor kidney transplantation which should be provided in accurate timing. Therefore, preemptive and non-preemptive kidney transplantations represent a single line of treatment which is implemented at different timings along the course of end-stage renal disease rather than two parallel lines. Hence, the perspective of lead-time bias could be ameliorated.

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Kidney transplantation in older recipients: Preemptive high KDPI kidney vs lower KDPI kidney after varying dialysis vintage

Cited by 15 publications

References 23 publications

What Are the Burden, Causes, and Costs of Early Hospital Readmissions After Kidney Transplantation?

What Are the Burden, Causes, and Costs of Early Hospital Readmissions After Kidney Transplantation?

Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantation

Advantaged Outcomes of Pre-emptive Living Donor Kidney Transplantation and the Effect of Bias

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