Recipient Outcomes for Expanded Criteria Living Kidney Donors: The Disconnect Between Current Evidence and Practice

Iordanous, Yiannis; Seymour, Nicole; Young, Ann; Johnson, John F.; Iansavichus, Arthur V.; Cuerden, Meaghan; Gill, John S.; Poggio, Emilio D.; Garg, Amit X.

doi:10.1111/j.1600-6143.2009.02671.x

Cited by 88 publications

(68 citation statements)

References 54 publications

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“…A 2007 survey of transplant centres demonstrated that older, more obese, hypertensive and non-related patients are more likely to be accepted as donors compared to the previous decade. [3][4][5] Long-term health outcomes for extended-criteria donors are less clear. 4 In an attempt to make the donor screening process consistent, several consensus statements outlining the medical and psychosocial evaluation exist.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] Long-term health outcomes for extended-criteria donors are less clear. 4 In an attempt to make the donor screening process consistent, several consensus statements outlining the medical and psychosocial evaluation exist. 6 However, discrepancies between practices of donor sites persist.…”

Section: Introductionmentioning

confidence: 99%

“…6 However, discrepancies between practices of donor sites persist. 3,4,7 The use of computed tomographic angiography (CTA) to assess the quality of donor kidneys and the renal vasculature is part of the donor workup. 3,5,8 There are inherent risks associated with the medical and radiological evaluation itself, including incidental pathological findings and the emotional impact of being turned down for donation.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating potential live-renal donors: Causes for rejection, deferral and planned procedure type, a single-centre experience

Perlis

Connelly

Honey

et al. 2013

CUAJ

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Background: Renal transplantation is the preferred therapy to extend life expectancy and quality of life for patients with chronic kidney disease. There are many barriers in the process of live kidney donation that prevent the timely progression from organ requirement to transplantation, including the progression of the live donor through a medical evaluation. We assess how easily patients complete the donor workup, how often the medical evaluation identifies significant incidental findings, and which surgical procedure is planned for organ retrieval. Methods: We reviewed our donor database and the minutes from our multidisciplinary rounds from 2002 to 2008 to assess how medical, radiological and psychological findings were used to decide on the candidacy of potential donors. Results: Half (50.2%) of patients did not pass the initial health screen. Of the 467 patients who progressed beyond the health screen to the computed tomographic angiogram evaluation, 48 (10.3%) were excluded as donors and 419 (89.7%) were accepted. Of those accepted, 136 (32.5%) were conditional on further medical workup. Of the patients accepted (n=419), 375 (89.5%) were planned for laparoscopic left-sided approach. Conclusions: The vast majority of patients who passed the initial health screen for kidney donation will be accepted as donors, but about one-third will require further workup. It is rare to identify life-threatening disease on screening computerized tomographic angiograph for kidney donor workup.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluating potential live-renal donors: Causes for rejection, deferral and planned procedure type, a single-centre experience

Perlis

Connelly

Honey

et al. 2013

CUAJ

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“…The number of functional nephrons is smaller in grafts from older donors than from younger donors [14,15]. The systematic analysis on the transplantation outcome that included function of the graft and survival of the recipients in the period 1980-2008 showed that kidney recipients from donors older than 60 years had a poorer 5-year outcome regarding graft function and survival of the recipients than those from younger donors [16]. In some countries, as shown in the Norwegian registry, 16% of living donors are older than 60 years, and 7.7% are over the age of 65, whereas in Canada 6% of donors are older than 60 years [18,19].…”

Section: Discussionmentioning

confidence: 99%

Monitoring of Renal Allograft Function with Different Equations: What are the Differences?

Bushljetikj¹,

Selim²,

Taneva³

et al. 2017

BANTAO Journal

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Introduction. Monitoring of graft function by creatinine concentrations in serum and calculated glomerular filtration rate (GFR) is recommended after kidney transplantation. KDIGO recommendations on the treatment of transplant patients advocate usage of one of the existing mathematical equations based on serum creatinine. We compared clinical application of three equations based on serum creatinine in monitoring the function of transplanted kidney. Methods. A total number of 55 adult patients who received their first renal allograft from living donors at our transplant center in between 2011-2014 were included into the study. Renal allograft GFR was estimated by the Cockroft-Gault, Nankivell and MDRD formula, and correlated with clinical parameters of donors and recipients. Results. The mean age of recipients was 35.7±9.5 (range 16-58), and the mean age of donors was 55.5±9.0 (34-77) years. Out of this group of 55 transplant patients, 50(90.91%) were on hemodialysis (HD) prior to transplantation. HD treatment was shorter than 24 months in 37(74%) transplant patients. The calculated GFR with MDRD equation showed the highest mean value at 6 and 12 months (68.46±21.5; 68.39±24.6, respectively) and the lowest at 48 months (42.79±12.9). According to the Cockroft&Gault equation GFR was the highest at 12 months (88.91±24.9) and the lowest at 48 months (66.53±18.1 ml/min). The highest mean level (80.53±17.7) of the calculated GFR with the Nankivell equation was obtained at 12 months and the lowest (67.81±16.7 ml/min) at 48 months. The values of Pearson's correlation coefficient between the calculated GFR and the MDRD at 2 years after transplantation accor-

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“…(33) Transplant recipients of kidneys from higher CrCl donors have higher rates of graft survival, patient survival and renal function (B). (46) Serial renal function assessment Changes in Cr and diuresis volume are used as criteria for diagnosing acute renal injury (ARI) (C) (1) (A).…”

Section: The Assessment Of Baseline Renal Functionmentioning

confidence: 99%

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: Parte III. Recomendações órgãos específicas

Westphal¹,

Filho²,

Vieira³

et al. 2011

Rev. bras. ter. intensiva

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Brain death (BD) alters the pathophysiology of patients and may damage the kidneys, the lungs, the heart and the liver. To obtain better quality transplant organs, intensive care physicians in charge of the maintenance of deceased donors should attentively monitor these organs. Careful hemodynamic, ventilatory and bronchial clearance management minimizes the loss of kidneys and lungs. The evaluation of cardiac function and morphology supports the transplant viability assessment of the heart. The monitoring of liver function, the management of the patient's metabolic status and the evaluation of viral serology are fundamental for organ selection by the transplant teams and for the care of the transplant recipient. OBJECTIVEThese guidelines are aimed at contributing to the institutional coordination of organ transplantation and will provide "real world" guidelines that are appropriate in the Brazilian context for the uniform care of the deceased donor. Ultimately, this aim of this guide is to increase the quality and quantity of transplantable organs. METHODOLOGYThe Writing and Planning Committee, comprised of young intensive care physicians and intensive medicine residents, conducted an extensive literature review. From this review, they formulated questions and forwarded the questions to all of the authors of this article. These initial questions served as the starting point for receiving suggestions for the formulation of other questions and definitions.The final questions were revised by the Executive Committee and were returned to the authors to develop the guidelines presented in this article.The questions guided the literature review, which was conducted using the P.I.C.O. methodology where P stands for the target population, I for the intervention, C for the control or comparative group and O for the clinical outcome.The retrieved articles were critically analyzed and categorized according to their grade of recommendation and the strength of the presented evidence in the following manner:

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Recipient Outcomes for Expanded Criteria Living Kidney Donors: The Disconnect Between Current Evidence and Practice

Cited by 88 publications

References 54 publications

Evaluating potential live-renal donors: Causes for rejection, deferral and planned procedure type, a single-centre experience

Evaluating potential live-renal donors: Causes for rejection, deferral and planned procedure type, a single-centre experience

Monitoring of Renal Allograft Function with Different Equations: What are the Differences?

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: Parte III. Recomendações órgãos específicas

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