Strategies for Making More Organs Available for Transplantation

Gridelli, Bruno

doi:10.1056/nejm200008103430606

Cited by 254 publications

(128 citation statements)

References 90 publications

(74 reference statements)

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“…Experimental (17,18) and clinical studies (19)(20)(21) underline an adverse effect of nephron underdosing. In one study (25), long-term graft function was better when two kidney grafts were transplanted as compared with one.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Donor Gender on Graft Survival

Zeier¹,

Döhler

Opelz

et al. 2002

Journal of the American Society of Nephrology

226

163

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ABSTRACT. Differences in actuarial graft survival according to donor gender have been reported for renal allografts and for cardiac and hepatic allografts, but for the latter in small series with limited biostatistical power. Using the large database of the Collaborative Transplant Study (CTS), this study is an evaluation of graft survival according to donor and recipient gender for renal (n = 124,911), cardiac (n = 25,432), and hepatic (n = 16,410) transplants. Confounders, such as calendar year, geographical area, race, donor and recipient age, HLA mismatch, cold ischemia time, and others, as well as interaction terms were taken into consideration. Death-censored actuarial renal allograft survival from female compared with male donors was less in female recipients and even more so in male recipients. The donor gender-associated risk ratio for graft loss was 1.15 in female recipients and 1.22 in male recipients. The age-gender interaction term was statistically significant, the gender effect being more pronounced for younger (16 to 45 yr) compared with older (>45 yr) donors. Serum creatinine concentrations 1 yr after transplantation were also higher for recipients with kidney grafts coming from female donors irrespective of recipient gender. For first cardiac transplants, graft survival was inferior when the donor was female and the recipient male, but no statistical difference according to donor gender was demonstrable in female recipients. For first hepatic transplants overall, no significant differences according to donor gender were noted. The proportion of recipients who had treatment for rejection crisis during the first year was higher for male recipients of kidneys from female donors compared with male donors. No difference according to donor gender was demonstrable in female recipients. For cardiac and hepatic grafts, no significant effect of donor gender on the proportion of patients treated for rejection episodes was noted. The data show that adverse effects of female donor gender for different organs is much less uniform than reported in the past. An important confounder is donor age. A gender effect on graft survival is also observed for cardiac allografts. Therefore, in addition to potential “nephron underdosing,” further pathomechanisms must play a role, possibly differences in immunogenicity according to donor gender. E-mail: martin_zeier@med.uni-heidelberg.de

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Section: Discussionmentioning

confidence: 99%

“…The general concept that the total number of nephrons transplanted is a determinant of long-term graft outcome has been well illustrated by experimental studies, where, all other things being equal, graft outcome was better when two kidneys were transplanted (18,19). Preliminary evidence in humans also appears to point in the same direction (20,21).…”

mentioning

confidence: 98%

The Effect of Donor Gender on Graft Survival

Zeier¹,

Döhler

Opelz

et al. 2002

Journal of the American Society of Nephrology

226

163

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“…Several alternatives have been proposed to bridge the gap between the supply of and the demand for organs (18). Improvement in the overall survival rates will reduce the need for second or third grafts, thus reducing the waiting lists.…”

Section: Opportunities For Improvementmentioning

confidence: 99%

Optimizing Cadaveric Organ Procurement: the Catalan and Spanish Experience

Miranda

Vilardell²,

Grinyó

2003

American Journal of Transplantation

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The need to face the increasing gap between the supply and the demand of transplants has led to the development of a permanent network of trained medical staff responsible for the organ donation and removal process in all centers accredited for that process. In Spain, this activity received a specific budget, like any other medical activity in hospitals, and the responsible staff became accountable for performance. This system dramatically increased the number of potential donors referred, not only young donors with trauma, but also elderly donors dying from stroke. The effect was that the donation rate increased by more than 100% in 10 years (from 14 to 34 donors per million population). Consequently, so did all the transplant figures. In some areas, such as Catalonia, it has been demonstrated that sustained kidney transplant activity of over 60 procedures per million population can maintain or slightly decrease the waiting list, despite increasing incidence and prevalence of end-stage renal failure. Quality monitoring of the donation and retrieval process shows that there are still opportunities for improvement if all potential donors are referred and all technical problems are overcome. Living donation and nonheart beating organ retrieval should also be promoted.

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“…This has resulted in prolonged waiting times, with increased dialysis-related morbidity and mortality (1). These factors have made patients less acceptable candidates for transplantation and ultimately affected patient and graft survival once transplantation has been achieved (3).…”

mentioning

confidence: 99%

“…Multiple innovative techniques have evolved in an attempt to utilize these wasted organs (5). One of these involves the utilization of double kidney transplants from extremely young or old donors to compensate for marginal allograft function (3). Recently, the University of Maryland and Stanford University have routinely accepted adult kidneys that have been discarded by other local centers and transplanted both kidneys into a single recipient (6).…”

mentioning

confidence: 99%

Dual Kidneys from Marginal Adult Donors as a Source For Cadaveric Renal Transplantation in the United States

Bunnapradist¹,

Gritsch²,

Peng³

et al. 2003

Journal of the American Society of Nephrology

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Abstract. The current organ shortage has led to the utilization of double kidney transplants from marginal adult donors, but outcomes data are limited. The United Network for Organ Sharing registry database was used to compare the outcomes of 403 dual adult kidney transplantations (DKT) and 11,033 single kidney transplantations (SKT) from 1997 to 2000. Graft and patient survival and the effect of multiple risk factors were evaluated. It was found that DKT patients were older, less sensitized, and received grafts from older, more mismatched donors with longer cold ischemia times. There was also a greater percentage of donors with a history of diabetes or hypertension and African-American recipients and donors in the DKT group. Graft survival was inferior in the DKT group, with a 7% lower graft survival rate at 1 yr. There was a higher incidence of primary nonfunction in the DKT group, although the incidence of delayed graft function, early rejection treatment, and graft thrombosis did not differ. Multivariate analysis was used to identify African-American recipient ethnicity and retransplant as risk factors for graft loss. Graft survival was comparable in DKT and SKT with donors over 55 yr of age. DKT resulted in inferior graft outcomes compared with SKT. When compared with SKT with donors over 55 yr of age, DKT resulted in similar graft outcomes. These otherwise discarded kidneys should be cautiously considered as a source of marginal donors.Kidney transplantation has become the treatment of choice for end-stage renal disease patients (1). The demand for kidney transplants has increased dramatically in the last several years. This is evidenced by the current waiting list, which has increased to more than 50,000 patients in the United States. The annual death rate for patients on the wait list is 6.3% (2). Despite the increased demand, the number of cadaver donors has remained stable and is clearly insufficient to keep pace with the dramatically increasing demand. This has resulted in prolonged waiting times, with increased dialysis-related morbidity and mortality (1). These factors have made patients less acceptable candidates for transplantation and ultimately affected patient and graft survival once transplantation has been achieved (3).The rapid increase in the number of patients awaiting transplantation has led many transplant centers to consider accepting older kidney donors with co-morbidities (4). Despite this, the number of organs retrieved but not transplanted has increased from 400 in 1990 to 1300 in 2000. Multiple innovative techniques have evolved in an attempt to utilize these wasted organs (5). One of these involves the utilization of double kidney transplants from extremely young or old donors to compensate for marginal allograft function (3). Recently, the University of Maryland and Stanford University have routinely accepted adult kidneys that have been discarded by other local centers and transplanted both kidneys into a single recipient (6). This practice has been adopted by multiple centers i...

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Strategies for Making More Organs Available for Transplantation

Cited by 254 publications

References 90 publications

The Effect of Donor Gender on Graft Survival

The Effect of Donor Gender on Graft Survival

Optimizing Cadaveric Organ Procurement: the Catalan and Spanish Experience

Dual Kidneys from Marginal Adult Donors as a Source For Cadaveric Renal Transplantation in the United States

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