Long-Term Outcomes and Discard Rate of Kidneys by Decade of Extended Criteria Donor Age

Messina, Maria; Diena, Davide; Dellepiane, Sergio; Guzzo, Gabriella; Sardo, Luca Lo; Fop, Fabrizio; Segoloni, Giuseppe; Amoroso, Antonio; Mapelli, Paola; Biancone, Luigi

doi:10.2215/cjn.06550616

Cited by 47 publications

(38 citation statements)

References 33 publications

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“…Furthermore, 51% of the donors had terminal creatinine > 1.5 mg/dl and 69% of the transplants were performed with kidneys with KDPI above 85%. These characteristics have been associated with higher discard rates . Experimental studies suggest that the combination of CNI and mTORi interferes with cellular aerobic metabolism, potentially limiting recovery from ischemia‐reperfusion injury in grafts with less functional reserves such as high KDPI kidneys .…”

Section: Discussionmentioning

confidence: 99%

Prospective randomized study comparing everolimus and mycophenolate sodium inde novokidney transplant recipients from expanded criteria deceased donor

et al. 2019

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Summary The optimal immunosuppressive regimen for recipients of expanded criteria donor (ECD) kidneys has not been identified. In this single‐center study, 171 recipients of ECD kidney transplants were randomized to receive antithymocyte globulin induction, and delayed introduction of reduced dose tacrolimus, prednisone and everolimus (r‐ATG/EVR, n = 88), or mycophenolate (r‐ATG/MPS, n = 83). No cytomegalovirus (CMV) pharmacological prophylaxis was used. The primary endpoint was the incidence of CMV infection/disease at 12 months. Secondary endpoints included treatment failure [first biopsy‐proven acute rejection (BPAR), graft loss, or death] and safety. Patients treated with EVR showed a 89% risk reduction (13.6 vs. 71.6%; HR 0.11, 95% CI 0.06–0.220, P < 0.001) in the incidence of first CMV infection/disease. Incidences of BPAR (16% vs. 5%, P = 0.021), graft loss (11% vs. 1%, P = 0.008), death (10% vs. 1%, P = 0.013), and treatment discontinuation (40% vs. 28%, P = 0.12) were higher in the r‐ATG/EVR, leading to premature study termination. Mean glomerular filtration rate was lower in r‐ATG/EVR (31.8 ± 18.8 vs. 42.6 ± 14.9, P < 0.001). In recipients of ECD kidney transplants receiving no CMV pharmacological prophylaxis, the use of everolimus was associated with higher treatment failure compared with mycophenolate despite the significant reduction in the incidence of CMV infection/disease (ClinicalTrials.gov.NCT01895049).

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Section: Discussionmentioning

confidence: 99%

Prospective randomized study comparing everolimus and mycophenolate sodium inde novokidney transplant recipients from expanded criteria deceased donor

et al. 2019

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“…Others have also shown equal survival of SKT and DKT from donors in the same age ranges (i.e., 60–69 and 70–79) [ 28 ]. Equal outcome with worst graft histology is commonly assumed to support the validity of DKT allocation by score [ 8 , 14 , 28 ]; contrary to this assumption are reports of good outcome of grafts with bad preimplantation biopsy, which would have indicated DKT according to the NITp protocol and are allocated to SKT without knowledge of biopsy data ([ 12 , 13 , 29 ] and personal data). We show here that allocation to SKT without biopsy of grafts from high-risk, older than 70 years, donors achieves similar survival than DKT from equally comorbid donors, provided that clinical suitability is carefully sought.…”

Section: Discussionmentioning

confidence: 99%

Renal Transplants from Older Deceased Donors: Use of Preimplantation Biopsy and Differential Allocation to Dual or Single Kidney Transplant according to Histological Score Has No Advantages over Allocation to Single Kidney Transplant by Simple Clinical Indication

Casati¹,

Colombo²,

Perrino³

et al. 2018

Journal of Transplantation

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Background Grafts from elderly donors (ECD) are increasingly allocated to single (SKT) or dual (DKT) kidney transplantation according to biopsy score. Indications and benefits of either procedure lack universal agreement. Methods A total of 302 ECD-transplants in period from Jan 1, 2000, to Dec 31, 2015, were allocated to SKT (SKTpre) on clinical grounds alone (before Dec 2010, pre-DKT era, n = 170) or according to a clinical-histological protocol (after Dec 2010, DKT era, n = 132) to DKT (n = 48), SKT biopsy-based protocol (“high-risk”, SKThr, n = 51), or SKT clinically based protocol (“low-risk”, SKTlr, n = 33). Graft and patient survival were compared between the two periods and between different transplant categories. Results Graft and overall survival in recipients from ECD in pre-DKT and DKT era did not differ (5-year graft survival 87.7% and 84.2%, resp.); equal survival in the 2 ECD periods was shown in both donor age ranges of 60–69 and >70-years, and in low-risk or high-risk ECD categories. Within the DKT protocol SKThr showed worst graft and overall survival in the 60–69 donor age range; DKT did not result in significantly better outcome than SKT from ECD in either era. One-year posttransplant creatinine clearance in recipients did not differ between any ECD transplant category. At 3 and 5 years after transplantation there were significantly higher total dialysis-free recipient life years from an equal donor number in the pre-DKT era than in the DKT protocol. Conclusions Use of a biopsy-based protocol to allocate grafts from aged donors to SKT or DKT did not result in better short term graft survival than a clinically based protocol with allocation only to SKT and reduced overall recipient dialysis-free life years in time.

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“…The rationale for each of these criteria is described in Table S1. The second query excluded patients < 18 years old and patients with metastatic cancer, as successful transplants have been reported from individuals with some of the exclusionary criteria used for the first query, including donors over age 60(19, 20), donors with bacteremia and other bloodstream infections (21–23), and HIV-positive to HIV-positive transplants. (24) We estimate that the actual number of potential imminent death kidney donors falls between these two estimates.…”

Section: Methodsmentioning

confidence: 99%

Potential yield of imminent death kidney donation

Denu

Mendonça

Fost

2018

American Journal of Transplantation

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About 99 000 people are waiting for a kidney in the United States, and many will die waiting. The concept of "imminent death" donation, a type of living donation, has been gaining attention among physicians, patients, and ethicists. We estimated the number of potential imminent death kidney donors at the University of Wisconsin Hospital and Clinics by assessing the number of annual deaths in individuals with normal kidney function. Based on a previous survey suggesting that one-third of patients might be willing to donate at imminent death, we estimate that between 76 and 396 people in the state of Wisconsin would be medically eligible and willing to donate each year at the time of imminent death. We extrapolated these numbers to all transplant centers in the United States, estimating that between 5925 and 31 097 people might be eligible and willing to donate each year. Our results suggest that allowing donation at imminent death and including discussions about organ donation in end-of-life planning could substantially reduce the nation's kidney waiting list while providing many more donors the opportunity to give this gift.

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Long-Term Outcomes and Discard Rate of Kidneys by Decade of Extended Criteria Donor Age

Cited by 47 publications

References 33 publications

Prospective randomized study comparing everolimus and mycophenolate sodium inde novokidney transplant recipients from expanded criteria deceased donor

Prospective randomized study comparing everolimus and mycophenolate sodium inde novokidney transplant recipients from expanded criteria deceased donor

Renal Transplants from Older Deceased Donors: Use of Preimplantation Biopsy and Differential Allocation to Dual or Single Kidney Transplant according to Histological Score Has No Advantages over Allocation to Single Kidney Transplant by Simple Clinical Indication

Potential yield of imminent death kidney donation

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