Living-Unrelated Donor Renal Transplantation: An Alternative to Living-Related Donor Transplantation?

Ahmad, Nadeem; Ahmed, Kamran; Khan, Muhammad Shamim; Calder, Francis; Mamode, Nizam; Taylor, J.; Koffman, G.

doi:10.1308/003588408x261636

Cited by 34 publications

(32 citation statements)

References 15 publications

(15 reference statements)

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“…In the early 1990s, the one‐year incidence of acute rejection was approximately 10% lower in recipients of a kidney graft from a living donor than a deceased donor , but the difference has since narrowed to only 1–2% due to factors such as improved immunosuppression and closer matching for deceased donor grafts. Living related donation does not appear to reduce the risk of acute rejection versus living unrelated donation, despite a significantly higher donor–recipient HLA disparity in recipients of a graft from living unrelated donors .…”

Section: Donor Clinical Characteristicsmentioning

confidence: 93%

Pretransplant identification of acute rejection risk following kidney transplantation

et al. 2013

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SummaryLack of an accepted definition for 'high immunological risk' hampers individualization of immunosuppressive therapy after kidney transplantation. For recipientrelated risk factors for acute rejection, the most compelling evidence points to younger age and African American ethnicity. Recipient gender, body mass, previous transplantation, and concomitant infection or disease do not appear to be influential. Deceased donation now has only a minor effect on rejection risk, but older donor age remains a significant predictor. Conventional immunological markers (human leukocyte antigen [HLA] mismatching, pretransplant anti-HLA alloantibodies, and panel reactive antibodies) are being reassessed in light of growing understanding about the role of donor-specific antibodies (DSA). At the time of transplant, delayed graft function is one of the most clear-cut risk factors for acute rejection. Extended cold ischemia time (≥24 h) may also play a contributory role. While it is not yet possible to establish conclusively the relative contribution of different risk factors for acute rejection after kidney transplantation, the available data point to variables that should be taken into account at the time of transplant. Together, these offer a realistic basis for planning an appropriate immunosuppression regimen in individual patients.

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Section: Donor Clinical Characteristicsmentioning

confidence: 93%

Pretransplant identification of acute rejection risk following kidney transplantation

et al. 2013

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“…The analysis was divided into 2 eras: era 1, 2005e2010 (n ¼ 53), was characterized by the use of open donor nephrectomy using the classical lumbotomy incision, and no use of ABOi donors; and era 2, 2011e2014 (n ¼ 78), which introduced LDN and acceptance of ABOi donors. In addition, we made a change in our approach to the promotion of living donation: at their first visit in the transplant clinic, all potential kidney transplant recipients were informed based on evidence from the literature of the importance of living donation as the best choice, of the comparable outcome of living-related and living-unrelated donation in terms of patient and graft survival [9,10], the advantages in terms of outcome, safety, cosmetic results, and decreased hospital duration of stay associated with the use of hand-assisted LDN [4e6,11], and the comparable outcome of ABOc and ABOi LDKT [7,8]. All donors underwent an extensive preoperative medical and psychological evaluation, in addition to the routine imaging studies, double-phase spiral computed tomography of the abdomen and pelvis with 3-dimensional angiographic study of renal vessel anatomy was performed.…”

Section: Methodsmentioning

confidence: 99%

Expanding the Living Donor Pool “Second Act”: Laparoscopic Donor Nephrectomy and ABO-Incompatible Kidney Transplantation Improve Donor Recruitment

Romagnoli¹,

Salerno²,

Mamode

et al. 2015

Transplantation Proceedings

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“…28 In a retrospective analysis of 322 living-donor kidney transplants, the mean estimated GFR was lower in unrelated than in related living kidney donors (49 ± 14 vs 59 ± 29 mL/min/ 1.73 m 2 ; P = .032). 54 Acute rejection-free survival (P = .018) and graft survival (P = .025) have been reported to be lower for unrelated living-donor transplants than for related living-donor transplants in a retrospective study of 779 kidney transplant recipients. 55 In addition, the mean estimated GFR was lower for unrelated kidney transplants than for related kidney transplants.…”

Section: Relatedness Human Leukocyte Antigen Matching and Abo Compamentioning

confidence: 97%

“…Table 2 summarizes the studies reporting the risk factors associated with the incidence of DGF in living-donor kidney transplants. 11,17,31,32,33,38,41,44,46,48,52,54,58,64,65 Treating risks associated with DGF Given the paucity of data about the effects of and the risk factors for DGF in living-donor kidney transplant, studies that focus on treating these risk factors are also limited. However, given the effects of DGF after living-donor kidney transplant, strategies to minimize or prevent the risk of DGF are needed.…”

Section: Other Risk Factorsmentioning

confidence: 99%

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2016

Exp Clin Transplant

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With an increased incidence of living-donor kidney transplants, in response to increasing unmet needs for renal transplant, a clear understanding of determinants of posttransplant outcomes is essential. The importance of delayed graft function in deceased-donor kidney transplant is now part of conventional medical wisdom, due to the large amount of evidence focused on this aspect. However, the same is not true for living-donor kidney transplant, partly due to lack of evidence on this crucial clinical question and partly due to lack of awareness about this issue. The current review aims to highlight the importance of delayed graft function as a crucial determinant of outcomes in living-donor kidney transplant. An exhaustive search of online medical databases was performed with appropriate search criteria to collect evidence about delayed graft function after living-donor kidney transplant, with a special focus on studies from the Middle East. Data on incidence, impact, risk factors, and possible prevention modalities of delayed graft function in patients undergoing living-donor kidney transplant are presented. A key finding of this review is that contemporary incidence rates reported from the Middle East are comparatively higher than those reported from outside the region. Although in absolute terms the incidence is lower than deceaseddonor kidney transplant, the effects of delayed graft function on graft rejection and graft and patient survival are sufficiently large to warrant the formulation of specific treatment protocols. Key to formulating prevention and treatment strategies is identifying discrete risk factors for delayed graft function. Although this evidence is scant, an overview has been provided. Further studies examining different aspects of delayed graft function incidence after living-donor kidney transplant are urgently needed to address a so far little known clinical question.

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Living-Unrelated Donor Renal Transplantation: An Alternative to Living-Related Donor Transplantation?

Cited by 34 publications

References 15 publications

Pretransplant identification of acute rejection risk following kidney transplantation

Pretransplant identification of acute rejection risk following kidney transplantation

Expanding the Living Donor Pool “Second Act”: Laparoscopic Donor Nephrectomy and ABO-Incompatible Kidney Transplantation Improve Donor Recruitment

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