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

Casati, Costanza; Colombo, Valeriana; Perrino, Marialuisa; Rossetti, O.; Querques, Marialuisa; Giacomoni, Alessandro; Binaggia, Agnese; Colussi, Giacomo

doi:10.1155/2018/4141756

Cited by 11 publications

(18 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lack of benefit experienced by these centres could be attributed to different histological scoring systems used, 23 interpathologist variability in reporting, 24,25 and selection of patients who are already prognostically adverse. 26 Locally, the average waiting time for kidney transplantation is 9 years, and the use of kidneys with very poor histological scores had been considered. On the other hand, the median age at which waitlisted patients receive a kidney is 48 years.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of pre‐transplant biopsy on 5‐year outcomes of expanded criteria donor kidney transplantation

Yap

Kee

et al. 2020

Nephrology

View full text Add to dashboard Cite

Aim: Compared to Standard Criteria Donors (SCD), Expanded Criteria Donor (ECD) kidneys are associated with poorer outcomes, although pre-transplant biopsy may mitigate risks. This study assessed 5-year outcomes of deceased-donor kidney transplant recipients, comparing recipients of ECD allografts evaluated histologically to recipients of SCD and ECD kidneys assessed clinically. Methods: This is a single-centre retrospective study. From November 2005 to December 2009 (Era 1), donors were assessed clinically for suitability for kidney donation. From December 2009 to October 2017 (Era 2), kidneys from ECDs and diabetics underwent pre-transplant biopsy and were allocated based on Remuzzi score. Outcomes of Era 1 and 2 recipients were compared. Results: ECD kidney transplantation increased from 30.4% to 40.0% from Era 1 to 2. Univariable Cox regression, stratified by transplant era, found that 5-year graft loss was highest with Era 1 ECD (HR 2.5, 95% CI 1.1-5.5, P = .027) while graft loss for Era 2 ECD recipients was similar to SCD recipients. There was no difference in 5-year recipient survival. Amongst Era 1 ECD recipients, 51.2% experienced rejection compared to 30.8-41.5% for other subgroups. Five-year eGFR was higher with Era 2 ECD at 48.4 (33.3-60.7) ml/min/1.73 m 2 compared to 42.2 (35.8-57.3) ml/min/1.73 m 2 for Era 1 ECD. However, these differences were not statistically significant. Conclusion: Introduction of pre-transplant biopsy assessment may be associated with improved outcomes of ECD kidney recipients such that they are now comparable to SCD kidney recipients, with benefits persisting over 5 years.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Some studies had not demonstrated the value of pre‐transplant biopsy assessment. The lack of benefit experienced by these centres could be attributed to different histological scoring systems used, 23 inter‐pathologist variability in reporting, 24,25 and selection of patients who are already prognostically adverse 26 …”

Section: Discussionmentioning

confidence: 99%

Impact of pre‐transplant biopsy on 5‐year outcomes of expanded criteria donor kidney transplantation

Yap

Kee

et al. 2020

Nephrology

View full text Add to dashboard Cite

show abstract

“…Two recent Italian studies on the utility of pre-implantation biopsy in allocating ECD kidneys[4,55] concluded that histological evaluation was not superior to donor clinical evaluation in allocating ECD kidneys either as a single kidney or as a dual kidney transplant. The authors concluded that, according to their experience, the histological score poorly evaluates the donor kidney quality.…”

Section: Histological Evaluation Of Donor Kidneysmentioning

confidence: 99%

“…Historically, the evaluation of the kidneys from ECDs has been made histologically by the so-called zero-time biopsy[4], by clinical evaluation of the donor by different kidney allocation scores or by a combination of histological and clinical parameters.…”

Section: Introductionmentioning

confidence: 99%

Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best?

Salvadori¹,

Tsalouchos²

2019

WJT

View full text Add to dashboard Cite

Organ shortage represents one of the major limitations to the development of kidney transplantation. To increase the donor pool and to answer the ever increasing kidney request, physicians are recurring to marginal kidneys as kidneys from older donors, from hypertensive or diabetic donors and from non-heart beating donors. These kidneys are known to have frequently a worse outcome in the recipients. To date major problem is to evaluate such kidneys in order to use or to discard them before transplantation. The use of such kidneys create other relevant question as whether to use them as single or dual transplant and to allocate them fairly according transplant programs. The pre-transplant histological evaluation, the clinical evaluation of the donor or both the criteria joined has been used and according the time each criterion prevailed over the others. Aim of this review has been to examine the advantages and the drawbacks of any criterion and how they have changed with time. To date any criterion has several limitations and several authors have argued for the development of new guidelines in the field of the kidney evaluation for transplantation. Several authors argue that the use of omic technologies should improve the organ evaluation and studies are ongoing to evaluate these technologies either in the donor urine or in the biopsies taken before transplantation.

show abstract

“…Deciding which kidneys from older donors should be implanted as two single transplants, as a dual transplant, or which should be discarded is challenging. Although some centers in the United Kingdom and internationally use preimplantation histologic evaluation to help identify which kidneys should be implanted as duals (2,8,9), no clinical or histologic parameters have been widely accepted to aid utilization decisions (10)(11)(12)(13)(14)(15)(16). There is also little clinical guidance regarding recipient selection, and many offering policies for kidneys from older donors are based on donor criteria alone (17,18).…”

Section: Introductionmentioning

confidence: 99%

Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom

Ibrahim

Greenhall

Summers

et al. 2020

CJASN

View full text Add to dashboard Cite

Background and objectivesKidneys from elderly deceased donors are often discarded after procurement if the expected outcomes from single kidney transplantation are considered unacceptable. An alternative is to consider them for dual kidney transplantation. We aimed to examine the utilization of kidneys from donors aged ≥60 years in the United Kingdom and compare clinical outcomes of dual versus single kidney transplant recipients.Design, setting, participants, & measurementsData from the United Kingdom Transplant Registry from 2005 to 2017 were analyzed. We examined utilization rates of kidneys retrieved from deceased donors aged ≥60 years, and 5-year patient and death-censored graft survival of recipients of dual and single kidney transplants. Secondary outcomes included eGFR. Multivariable analyses and propensity score analysis were used to correct for differences between the groups.ResultsDuring the study period, 7841 kidneys were procured from deceased donors aged ≥60 years, of which 1338 (17%) were discarded; 356 dual and 5032 single kidneys were transplanted. Donors of dual transplants were older (median, 73 versus 66 years; P<0.001) and had higher United States Kidney Donor Risk Indices (2.48 versus 1.98; P<0.001). Recipients of dual transplants were also older (64 versus 61 years; P<0.001) and had less favorable human leukocyte antigen matching (P<0.001). After adjusting for confounders, dual and single transplants had similar 5-year graft survival (hazard ratio, 0.81; 95% CI, 0.59 to 1.12). No difference in patient survival was demonstrated. Similar findings were observed in a matched cohort with a propensity score analysis method. Median 12-month eGFR was significantly higher in the dual kidney transplant group (40 versus 36 ml/min per 1.73 m2; P<0.001).ConclusionsRecipients of kidneys from donors aged ≥60 years have similar 5-year graft survival and better graft function at 12 months with dual compared with single deceased donor kidney transplants.

show abstract

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

Cited by 11 publications

References 28 publications

Impact of pre‐transplant biopsy on 5‐year outcomes of expanded criteria donor kidney transplantation

Impact of pre‐transplant biopsy on 5‐year outcomes of expanded criteria donor kidney transplantation

Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best?

Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom

Contact Info

Product

Resources

About