Perfusion Parameters of Donation After Cardiac Death Kidneys Predict Early Transplant Outcomes Based on Expanded Criteria Donor Designation

Tai, Qian-Hui; Xue, Wei; Ding, Xiaoming; Tian, Peng; Xiang, Hao; Xiong, Feng; H, Yan; Hou, Jianquan

doi:10.1016/j.transproceed.2017.11.018

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…Notably, the degree of protection is similar to the reduction in DGF observed through use of hypothermia (aOR 0.62), although this has not been compared in a head to head comparison. Pulsatile perfusion may offer additional benefits, as pump parameters may provide additional clinical data on the likelihood of DGF or primary non‐function (PNF), although the accuracy of predictions made from pump parameters on long‐term outcomes remains controversial . In contrast, hypothermia also does not require the use of specific technology which is not universally available, particularly in centers outside of the United States and western Europe.…”

Section: Discussionmentioning

confidence: 99%

Modeling the economic benefit of targeted mild hypothermia in deceased donor kidney transplantation

Axelrod

Malinoski

Patel

et al. 2019

Clinical Transplantation

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Delayed graft function (DGF) in kidney transplant significantly increases inpatient and outpatient cost. Targeted, mild hypothermia in organ donors after neurologic determination of death significantly reduced the rate of DGF in a recent randomized controlled clinical trial. To assess the potential economic benefit of national implementation of donor hypothermia, rates of reduction DGF were combined with estimates of the impact of DGF on hospital cost and total health expenditure for standard and extended criteria donor organs (SCD and ECD). DGF increases the cost of the transplant episode by $9487 for ECD transplant and $10 342 for SCD transplant. Medicare recipients with DGF incur an additional $18 513 spending for ECD and $14 948 in SCD transplants over the first year. An absolute reduction in DGF rate after kidney transplantation consistent with trial results (ECD 25%, SCD 7%) has the potential to lower annual hospital cost for kidney transplant by $13 178 746 and annual Medicare spending by $20 970 706 compared to standard donor management practice using static cold storage. Targeted mild hypothermia improves care of renal transplant patients by safely reducing DGF rates in both ECD and SCD transplant. Broader application of this safe, effective, and low-cost intervention could reduce healthcare expenditures for providers and insurers. K E Y W O R D S cost, deceased organ donors, donor management, hypothermia 1 | INTRODUC TI ON The development of delayed graft function (DGF) after kidney transplantation has been increasing in recent years. Following implementation of the new Kidney Allocation System (KAS) in the United States, rates of DGF increased from 24.3% to 29.5% of all kidney transplant procedures. 1 The development of DGF has significant detrimental clinical and economic impacts for transplant 2 of 7 | AXELROD Et AL.recipients. 2-4 Clinically, patients with DGF experience higher rates of acute rejection contributing to the development of donor-specific antibodies and shortening long-term graft survival. 5-7 Economically, DGF results in longer length of stay, increased need for expensive lymphocyte depleting induction therapies, and an greater rate of return to dialysis. 3,8 A variety of modifiable and unmodifiable donor and transplant factors impact DGF rates. Donor demographic characteristics including creatinine, age, and recovery after cardiac death significantly increase the risk of DGF, as do recipient race (black), age, gender (male), and time on dialysis. It is also well established that increased cold ischemic time is associated with more DGF, which may explain the greater incidence of DGF after implementation of the KAS system. Strategies to prevent the development of DGF in the United States have generally been employed after organ recovery and have historically been expensive. Pulsatile perfusion of kidney allografts is associated with reduction in the incidence of DGF, especially in high-risk organs, but increases the initial cost of transplant. 3,9 Furthermore, a sizable number of kidney...

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Section: Discussionmentioning

confidence: 99%

Modeling the economic benefit of targeted mild hypothermia in deceased donor kidney transplantation

Axelrod

Malinoski

Patel

et al. 2019

Clinical Transplantation

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“…When we found a kidney that was reddish in color or slightly tough in texture, we used LifePort to evaluate and improve its quality before making a decision. A flow of > 80 mL/min was the screening criterion of transplantation qualification [13]. We chose 30 mmHg as the initial pressure and 2 h as the average perfusion time If the average terminal flow was less than 80 mL/min, the kidney was discarded.…”

Section: Lifeportmentioning

confidence: 99%

Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation

et al. 2020

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Background Delayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival. Methods This retrospective study on kidney transplantation was conducted from January 1, 2018, to December 31, 2019, at the Second Xiangya Hospital of Central South University. We classified recipients whose operations were performed in different years into training and validation cohorts and used data from the training cohort to analyze predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors. Results The incidence rate of DGF was 16.92%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), terminal serum creatine (Scr) concentration, duration of pretransplant dialysis, primary cause of donor death, and usage of LifePort. The internal accuracy of the nomogram was 83.12%. One-year graft survival rates were 93.59 and 99.74%, respectively, for the groups with and without DGF (P < 0.05). Conclusion The nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival.

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“…When we found a kidney that was reddish in color or slightly tough in texture, we used LifePort to evaluate and improve its quality before making a decision. A ow of >80 mL/min was the screening criterion of transplantation quali cation [13]. We chose 30 mmHg as the initial pressure and 2 hours as the average perfusion time If the average terminal ow was less than 80 mL/min, the kidney was discarded.…”

Section: Lifeportmentioning

confidence: 99%

Predictors and One-year Outcomes of Patients with Delayed Graft Function after Deceased Donor Kidney Transplantation

Chen

Wang

Song

et al. 2020

Preprint

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Background:Delayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival.Methods:This retrospective study on kidney transplantation was conducted from January 1, 2018, to December 31, 2019, at the Second Xiangya Hospital of Central South University. We classified recipients whose operations were performed in different years into training and validation cohorts and used data from the training cohort to analyze predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors.Results:The incidence rate of DGF was 16.92%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), terminal serum creatine (Scr) concentration,, duration of pretransplant dialysis, primary cause of donor death, and usage of LifePort . The internal accuracy of the nomogram was 83.12%. One-year graft survival rates were 93.59% and 99.74%, respectively, for the groups with and without DGF (P<0.05).Conclusion:The nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival.

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Perfusion Parameters of Donation After Cardiac Death Kidneys Predict Early Transplant Outcomes Based on Expanded Criteria Donor Designation

Cited by 9 publications

References 17 publications

Modeling the economic benefit of targeted mild hypothermia in deceased donor kidney transplantation

Modeling the economic benefit of targeted mild hypothermia in deceased donor kidney transplantation

Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation

Predictors and One-year Outcomes of Patients with Delayed Graft Function after Deceased Donor Kidney Transplantation

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