Living related and living unrelated kidney transplantations: A systematic review and meta-analysis

Simforoosh, Nasser; Shemshaki, Hamidreza; Nadjafi-Semnani, Mohammad; Sotoudeh, Mehdi

doi:10.5500/wjt.v7.i2.152

Cited by 16 publications

(10 citation statements)

References 21 publications

(27 reference statements)

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“…Living donor kidneys are associated with better graft survival when compared to deceased donor kidneys, mostly due to the better quality of the grafts (i.e. less ischaemic injury), short ischaemia time, scheduled surgery and higher probability of pre‐emptive transplantation [17–19].…”

Section: Discussionmentioning

confidence: 99%

The association of living donor source with patient and graft survival among kidney transplant recipients in the ERA‐EDTA Registry – a retrospective study

et al. 2020

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Summary In this study we aimed to compare patient and graft survival of kidney transplant recipients who received a kidney from a living‐related donor (LRD) or living‐unrelated donor (LUD). Adult patients in the ERA‐EDTA Registry who received their first kidney transplant in 1998–2017 were included. Ten‐year patient and graft survival were compared between LRD and LUD transplants using Cox regression analysis. In total, 14 370 patients received a kidney from a living donor. Of those, 9212 (64.1%) grafts were from a LRD, 5063 (35.2%) from a LUD and for 95 (0.7%), the donor type was unknown. Unadjusted five‐year risks of death and graft failure (including death as event) were lower for LRD transplants than for LUD grafts: 4.2% (95% confidence interval [CI]: 3.7–4.6) and 10.8% (95% CI: 10.1–11.5) versus 6.5% (95% CI: 5.7–7.4) and 12.2% (95% CI: 11.2–13.3), respectively. However, after adjusting for potential confounders, associations disappeared with hazard ratios of 0.99 (95% CI: 0.87–1.13) for patient survival and 1.03 (95% CI: 0.94–1.14) for graft survival. Unadjusted risk of death‐censored graft failure was similar, but after adjustment, it was higher for LUD transplants (1.19; 95% CI: 1.04–1.35). In conclusion, patient and graft survival of LRD and LUD kidney transplant recipients was similar, whereas death‐censored graft failure was higher in LUD. These findings confirm the importance of both living kidney donor types.

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Section: Discussionmentioning

confidence: 99%

The association of living donor source with patient and graft survival among kidney transplant recipients in the ERA‐EDTA Registry – a retrospective study

et al. 2020

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“…A possibility to expand the donor pool is the use of living unrelated donors. Graft outcome after LURD was shown to be superior to DD (52)(53)(54). In adults, rates of LURD are relatively high since donors are often the partner or a friend.…”

Section: Living Unrelated Donors (Lurd)mentioning

confidence: 99%

Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades

et al. 2022

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Worldwide, over 1,300 pediatric kidney transplantations are performed every year. Since the first transplantation in 1959, healthcare has evolved dramatically. Pre-emptive transplantations with grafts from living donors have become more common. Despite a subsequent improvement in graft survival, there are still challenges to face. This study attempts to summarize how our understanding of pediatric kidney transplantation has developed and improved since its beginnings, whilst also highlighting those areas where future research should concentrate in order to help resolve as yet unanswered questions. Existing literature was compared to our own data of 411 single-center pediatric kidney transplantations between 1968 and 2020, in order to find discrepancies and allow identification of future challenges. Important issues for future care are innovations in immunosuppressive medication, improving medication adherence, careful donor selection with regard to characteristics of both donor and recipient, improvement of surgical techniques and increased attention for lower urinary tract dysfunction and voiding behavior in all patients.

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“…Thus, the safety and efficacy of allogenic transplants are ensured by immunological matching/compatibility, based on detection of pre‐existing donor‐specific HLA alloantibodies in the recipient's blood in addition to the donor and recipient HLA tissue types. In the current era, the safety and efficacy of related and unrelated but appropriately matched donor/recipient pairs are comparable 12,13 . Additionally, rules of immunological matching might differ among various HCT/P therapies and treated diseases.…”

Section: Why Are Allo‐islets and Auto‐islets Regulated Differently Dementioning

confidence: 99%

The demise of islet allotransplantation in the United States: A call for an urgent regulatory update

Witkowski

Philipson

Kaufman

et al. 2021

American Journal of Transplantation

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Islet allotransplantation in the United States (US) is facing an imminent demise. Despite nearly three decades of progress in the field, an archaic regulatory framework has stymied US clinical practice. Current regulations do not reflect the state‐of‐the‐art in clinical or technical practices. In the US, islets are considered biologic drugs and “more than minimally manipulated” human cell and tissue products (HCT/Ps). In contrast, across the world, human islets are appropriately defined as “minimally manipulated tissue” and not regulated as a drug, which has led to islet allotransplantation (allo‐ITx) becoming a standard‐of‐care procedure for selected patients with type 1 diabetes mellitus. This regulatory distinction impedes patient access to islets for transplantation in the US. As a result only 11 patients underwent allo‐ITx in the US between 2016 and 2019, and all as investigational procedures in the settings of a clinical trials. Herein, we describe the current regulations pertaining to islet transplantation in the United States. We explore the progress which has been made in the field and demonstrate why the regulatory framework must be updated to both better reflect our current clinical practice and to deal with upcoming challenges. We propose specific updates to current regulations which are required for the renaissance of ethical, safe, effective, and affordable allo‐ITx in the United States.

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Living related and living unrelated kidney transplantations: A systematic review and meta-analysis

Cited by 16 publications

References 21 publications

The association of living donor source with patient and graft survival among kidney transplant recipients in the ERA‐EDTA Registry – a retrospective study

The association of living donor source with patient and graft survival among kidney transplant recipients in the ERA‐EDTA Registry – a retrospective study

Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades

The demise of islet allotransplantation in the United States: A call for an urgent regulatory update

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