Long-Term Outcomes of Kidney Transplantation From Expanded Criteria Deceased Donors at a Single Center: Comparison With Standard Criteria Deceased Donors

Hwang, Jeong Kye; Park, S.C.; Kwon, Kui Hyang; Choi, Bum Soon; Kim, J.I.; Yang, Chul Woo; Kim, Y.S.; Moon, In Sung

doi:10.1016/j.transproceed.2013.11.061

Cited by 26 publications

(19 citation statements)

References 15 publications

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“…Notably, in a metaanalysis of six clinical trials comparing belatacept with either CsA or tacrolimus, belatacept was associated with significantly greater eGFR at 12, 24 and 36 mo after transplant (32). This result is important from a clinical perspective because recipients of ECD kidneys tend to have statistically significantly lower GFR values than those who receive standard criteria donor kidneys (33)(34)(35)(36). A non-nephrotoxic immunosuppressive regimen may help to maintain ECD renal function, delaying the time that recipients of such kidneys progress to chronic kidney disease, must return to maintenance dialysis and/ or undergo retransplantation.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes in Belatacept- Versus Cyclosporine-Treated Recipients of Extended Criteria Donor Kidneys: Final Results From BENEFIT-EXT, a Phase III Randomized Study

Dürrbach

Pestana

Florman

et al. 2016

American Journal of Transplantation

121

123

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In the Belatacept Evaluation of Nephroprotection and Efficacy as First‐Line Immunosuppression Trial–Extended Criteria Donors (BENEFIT‐EXT), extended criteria donor kidney recipients were randomized to receive belatacept‐based (more intense [MI] or less intense [LI]) or cyclosporine‐based immunosuppression. In prior analyses, belatacept was associated with significantly better renal function compared with cyclosporine. In this prospective analysis of the intent‐to‐treat population, efficacy and safety were compared across regimens at 7 years after transplant. Overall, 128 of 184 belatacept MI–treated, 138 of 175 belatacept LI–treated and 108 of 184 cyclosporine‐treated patients contributed data to these analyses. Hazard ratios (HRs) comparing time to death or graft loss were 0.915 (95% confidence interval [CI] 0.625–1.339; p = 0.65) for belatacept MI versus cyclosporine and 0.927 (95% CI 0.634–1.356; p = 0.70) for belatacept LI versus cyclosporine. Mean estimated GFR (eGFR) plus or minus standard error at 7 years was 53.9 ± 1.9, 54.2 ± 1.9, and 35.3 ± 2.0 mL/min per 1.73 m2 for belatacept MI, belatacept LI and cyclosporine, respectively (p < 0.001 for overall treatment effect). HRs comparing freedom from death, graft loss or eGFR <20 mL/min per 1.73 m2 were 0.754 (95% CI 0.536–1.061; p = 0.10) for belatacept MI versus cyclosporine and 0.706 (95% CI 0.499–0.998; p = 0.05) for belatacept LI versus cyclosporine. Acute rejection rates and safety profiles of belatacept‐ and cyclosporine‐based treatment were similar. De novo donor‐specific antibody incidence was lower for belatacept (p ≤ 0.0001). Relative to cyclosporine, belatacept was associated with similar death and graft loss and improved renal function at 7 years after transplant and had a safety profile consistent with previous reports.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes in Belatacept- Versus Cyclosporine-Treated Recipients of Extended Criteria Donor Kidneys: Final Results From BENEFIT-EXT, a Phase III Randomized Study

Dürrbach

Pestana

Florman

et al. 2016

American Journal of Transplantation

121

123

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“…In an attempt to overcome this hurdle, there has been a recent increase in the use of grafts from donation after circulatory death and extended criteria donors. While successfully increasing the donor pool, these grafts have increased susceptibility to the damage caused by ischemia and reperfusion and are therefore prone to increased rates of delayed graft function (DGF) and poorer graft survival …”

Section: Introductionmentioning

confidence: 99%

Hypothermic machine perfusion is superior to static cold storage in deceased donor kidney transplantation: A meta‐analysis

Tingle

Figueiredo

Moir

et al. 2020

Clinical Transplantation

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Background There remains a lack of consensus on the optimal storage method for deceased donor kidneys. This meta‐analysis compares storage with hypothermic machine perfusion (HMP) vs traditional static cold storage (SCS). Methods The Cochrane Kidney and Transplant Specialised Register was searched to identify (quasi‐) randomized controlled trials (RCTs) to include in our meta‐analysis. PRISMA guidelines were used to perform and write this review. Results There is high‐certainty evidence that HMP reduces the risk of delayed graft function (DGF) when compared to SCS (2138 participants from 14 studies, RR = 0.77; 0.67‐0.90, P = .0006). This benefit is significant in both donation following circulatory death (DCD; 772 patients from seven studies, RR = 0.75; 0.64‐0.87, P = .0002) and donation following brainstem death (DBD) grafts (971 patients from four studies, RR = 0.78; 0.65‐0.93, P = .006). The number of perfusions required to prevent one episode of DGF was 7.26 and 13.60 in DCD and DBD grafts, respectively. There is strong evidence that HMP also improves graft survival in both DBD and DCD grafts, at both 1 and 3 years. Economic analyses suggest HMP is cost‐saving at 1 year compared with SCS. Conclusion Hypothermic machine perfusion is superior to SCS in deceased donor renal transplantation. Direct comparisons with normothermic machine perfusion in RCTs are essential to identify optimal preservation methods in kidney transplantation.

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“…The sustained shortage has galvanized the use of sub-optimal organs from donation after circulatory death (DCD) and extended criteria donors (ECD) [1]. These marginal organs tolerate cold storage poorly and higher rates of primary non-function (PNF) and delayed graft function (DGF) are attributed to an increased susceptibility to ischemia-reperfusion injury (IRI) [2,3]. Research efforts have focused on overcoming the limitations of cold storage with a move toward normothermic machine perfusion (NMP).…”

Section: Editorialmentioning

confidence: 99%

Optimising organs for transplantation: is normothermic machine perfusion the answer?

Chadha¹,

Hossain²,

Bagul³

2016

Expert Review of Medical Devices

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Long-Term Outcomes of Kidney Transplantation From Expanded Criteria Deceased Donors at a Single Center: Comparison With Standard Criteria Deceased Donors

Cited by 26 publications

References 15 publications

Long-Term Outcomes in Belatacept- Versus Cyclosporine-Treated Recipients of Extended Criteria Donor Kidneys: Final Results From BENEFIT-EXT, a Phase III Randomized Study

Long-Term Outcomes in Belatacept- Versus Cyclosporine-Treated Recipients of Extended Criteria Donor Kidneys: Final Results From BENEFIT-EXT, a Phase III Randomized Study

Hypothermic machine perfusion is superior to static cold storage in deceased donor kidney transplantation: A meta‐analysis

Optimising organs for transplantation: is normothermic machine perfusion the answer?

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