Risk factors and outcome of expanded-criteria donor kidney transplants in patients with low immunological risk

Praehauser, Claudia; Hirt‐Minkowski, Patricia; Bakar, Kiymet Saydam; Amico, Patrizia; Vogler, E; Schaub, Stefan; Mayr, Michael

doi:10.4414/smw.2013.13883

Cited by 7 publications

(11 citation statements)

References 49 publications

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“…Nonadjusted survival curves were correctly reported in 29 publications for ECD kidney recipients and in 21 publications for SCD kidney recipients . Pooled nonadjusted survival is presented in Fig.…”

Section: Resultsmentioning

confidence: 81%

“…A total of 135 publications were excluded because the ECD definition was incorrect or lacking, and 82 because of statistical inadequacies in the survival analysis. Thirty‐two publications were finally included in this study . The corresponding main characteristics are summarized in Table .…”

Section: Resultsmentioning

confidence: 99%

“…Characteristics of donors, recipients, and transplantations are detailed in Table . Among the 32 publications, 25 (78%) also included SCD kidney recipients . Transplantation periods ranged from 1990 to 2010.…”

Section: Resultsmentioning

confidence: 99%

“…Most of the recipients were transplanted after 2000, earlier transplants being a posteriori reclassified as ECD/SCD. The information related to the Donation after Circulatory Death (DCD) was not specified in 19 publications (59%) . Seventeen publications described baseline clinical characteristics for both the ECD and SCD groups.…”

Section: Resultsmentioning

confidence: 99%

“…Among the 32 publications, 13 (40%) used a survival model to compare the effect of ECD and SCD status on graft and/or patient outcomes. Nevertheless, eight publications were excluded because of methodological issues: HR adjusted on donor age , or without any specification of adjustment factors , no adjustment , or a reference group different from SCD recipients . Finally, five publications were retained for this analysis , and all were based on US recipients.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Comparison of survival outcomes between Expanded Criteria Donor and Standard Criteria Donor kidney transplant recipients: a systematic review and meta-analysis

et al. 2016

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SUMMARYIn 2002, the United Network for Organ Sharing proposed increasing the pool of donor kidneys to include Expanded Criteria Donor (ECD). Outside the USA, the ECD definition remains the one used without questioning whether such a graft allocation criterion is valid worldwide. We performed a meta-analysis to quantify the differences between ECD and Standard Criteria Donor (SCD) transplants. We paid particular attention to select studies in which the methodology was appropriate and we took into consideration the geographical area. Thirty-two publications were included. Only five studies, all from the USA, reported confounderadjusted hazard ratios comparing the survival outcomes between ECD and SCD kidney transplant recipients. These five studies confirmed that ECD recipients seemed to have poorer prognosis. From 29 studies reporting appropriate survival curves, we estimated the 5-year pooled nonadjusted survivals for ECD and SCD recipients. The relative differences between the two groups were lower in Europe than in North America, particularly for death-censored graft failure. It is of primary importance to propose appropriate studies for external validation of the ECD criteria in non-US kidney transplant recipients.

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Section: Resultsmentioning

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of survival outcomes between Expanded Criteria Donor and Standard Criteria Donor kidney transplant recipients: a systematic review and meta-analysis

et al. 2016

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Comparisons of the performance of different statistical tests for time‐to‐event analysis with confounding factors: practical illustrations in kidney transplantation

Borgne

Giraudeau

Querard

et al. 2015

Statistics in Medicine

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Confounding factors are commonly encountered in observational studies. Several confounder-adjusted tests to compare survival between differently exposed subjects were proposed. However, only few studies have compared their performances regarding type I error rates, and no study exists evaluating their type II error rates. In this paper, we performed a comparative simulation study based on two different applications in kidney transplantation research. Our results showed that the propensity score-based inverse probability weighting (IPW) log-rank test proposed by Xie and Liu (2005) can be recommended as a first descriptive approach as it provides adjusted survival curves and has acceptable type I and II error rates. Even better performance was observed for the Wald test of the parameter corresponding to the exposure variable in a multivariable-adjusted Cox model. This last result is of primary interest regarding the exponentially increasing use of propensity score-based methods in the literature.

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Strategies for an Expanded Use of Kidneys From Elderly Donors

Pérez‐Sáez

Montero²,

Redondo-Pachón³

et al. 2017

Transplantation

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The old-for-old allocation policy used for kidney transplantation (KT) has confirmed the survival benefit compared to remaining listed on dialysis. Shortage of standard donors has stimulated the development of strategies aimed to expand acceptance criteria, particularly of kidneys from elderly donors. We have systematically reviewed the literature on those different strategies. In addition to the review of outcomes of expanded criteria donor or advanced age kidneys, we assessed the value of the Kidney Donor Profile Index policy, preimplantation biopsy, dual KT, machine perfusion and special immunosuppressive protocols. Survival and functional outcomes achieved with expanded criteria donor, high Kidney Donor Profile Index or advanced age kidneys are poorer than those with standard ones. Outcomes using advanced age brain-dead or cardiac-dead donor kidneys are similar. Preimplantation biopsies and related scores have been useful to predict function, but their applicability to transplant or refuse a kidney graft has probably been overestimated. Machine perfusion techniques have decreased delayed graft function and could improve graft survival. Investing 2 kidneys in 1 recipient does not make sense when a single KT would be enough, particularly in elderly recipients. Tailored immunosuppression when transplanting an old kidney may be useful, but no formal trials are available.Old donors constitute an enormous source of useful kidneys, but their retrieval in many countries is infrequent. The assumption of limited but precious functional expectancy for an old kidney and substantial reduction of discard rates should be generalized to mitigate these limitations.

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Risk factors and outcome of expanded-criteria donor kidney transplants in patients with low immunological risk

Abstract: Tac-based immunosuppression seems to improve graft survival and to preserve graft function in ECD kidneys with low immunological risk.

Cited by 7 publications

References 49 publications

Comparison of survival outcomes between Expanded Criteria Donor and Standard Criteria Donor kidney transplant recipients: a systematic review and meta-analysis

Comparison of survival outcomes between Expanded Criteria Donor and Standard Criteria Donor kidney transplant recipients: a systematic review and meta-analysis

Comparisons of the performance of different statistical tests for time‐to‐event analysis with confounding factors: practical illustrations in kidney transplantation

Strategies for an Expanded Use of Kidneys From Elderly Donors

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