The Effect of Donors’ Demographic Characteristics in Renal Function Post-Living Kidney Donation. Analysis of a UK Single Centre Cohort

Bellini, Maria Irene; Charalampidis, Sotiris; Stratigos, Ioannis; Dor, Frank J. M. F.; Papalois, Vassilios

doi:10.3390/jcm8060883

Cited by 24 publications

(24 citation statements)

References 30 publications

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“…A recent study of 133,824 living kidney donors showed that older age groups had higher risk of ESRD among nonblack donors ( Massie et al, 2017 ). Another study including 889 living kidney donors showed that older age was associated with a lesser recovery of eGFR ( Bellini et al, 2019 ). However, as compared with age-matched common people, older living donors did not demonstrate higher risk for renal failure or long-term mortality ( Berger et al, 2011 ; Ibrahim et al, 2009 ).…”

Section: Ageing and Kidney Transplantationmentioning

confidence: 99%

The ageing kidney: Molecular mechanisms and clinical implications

Fang

Gong

Haller

et al. 2020

Ageing Research Reviews

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As human life expectancy keeps increasing, ageing populations present a growing challenge for clinical practices. Human ageing is associated with molecular, structural, and functional changes in a variety of organ systems, including the kidney. During the ageing process, the kidney experiences progressive functional decline as well as macroscopic and microscopic histological alterations, which are accentuated by systemic comorbidities like hypertension and diabetes mellitus, or by preexisting or underlying kidney diseases. Although ageing per se does not cause kidney injury, physiologic changes associated with normal ageing processes are likely to impair the reparative capacity of the kidney and thus predispose older people to acute kidney disease, chronic kidney disease and other renal diseases. Mechanistically, cell senescence plays a key role in renal ageing, involving a number of cellular signaling mechanisms, many of which may be harnessed as interventional targets for slowing or even reversing kidney ageing. This review summarizes the clinical characteristics of renal ageing, highlights the latest progresses in deciphering the role of cell senescence in renal ageing, and envisages potential interventional strategies and novel therapeutic targets for preventing or improving renal ageing in the hope of maintaining long-term kidney health and function across the life course.

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Section: Ageing and Kidney Transplantationmentioning

confidence: 99%

The ageing kidney: Molecular mechanisms and clinical implications

Fang

Gong

Haller

et al. 2020

Ageing Research Reviews

View full text Add to dashboard Cite

show abstract

“…Modifiable risk factors, such as smoking and elevated BMI, that impede the health and well-being of patients and appear to contribute to hypertension should be addressed, although these should not be considered per se a contraindication to donate [ 62 ]. Older donors should be counselled on the apparent increased likelihood of developing hypertension.…”

Section: Treatment and Prevention Of Postdonation Hypertension In mentioning

confidence: 99%

Prevalence, Mechanisms, Treatment, and Complications of Hypertension Postliving Kidney Donation

Deoraj

Moutzouris

Bellini

2021

BioMed Research International

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Living kidney donors represent a unique population of patients. Potential donors are selected based on the belief that their preoperative fitness is likely to mitigate the risks of long- and short-term harm following uninephrectomy. Studies performed on postdonation outcomes have largely focused on mortality and the risk of end-stage renal failure, but have also investigated secondary outcomes such as cardiovascular morbidity and hypertension. It has been postulated that hypertension is a possible outcome of living kidney donation. A variety of studies have been conducted to investigate the prevalence, epidemiology, mechanisms, treatment strategies, and long-term ramifications of hypertension postdonation. These studies are heterogeneous in their population, design, methodology, and outcome measures and have presented contradicting outcomes. Additionally, the absence of a well-matched control group has made it challenging to interpret and generalise the reported findings. As such, it is not possible to definitively conclude that hypertension occurs at a higher rate among donors than the general population. This article will review the evidence of postdonation hypertension prevalence, mechanisms, treatment, and complications.

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“…In our centre, where there is a high rate of living donor transplantation, there is for this reason an even higher proportion of organs retrieved from living donors in the case of 3rd+ KTRs (Table 1). To overcome living donor shortage, broad educational campaigns aiming to educate and inform the general population [21] and particularly via social media, have demonstrated an increase in donation rates [22]. With the current organ donor shortage and more patients dying on the waiting list, living donor kidney donation seems, therefore, to satisfy and significantly contribute to expand the donor pool for the general population, and more specifically for those who might not survive a long waiting list time or a major operation, like in the case of the repeated kidney transplantation subgroup.…”

Section: Discussionmentioning

confidence: 99%

Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants

Bellini

Courtney

McCaughan

2020

JCM

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Background: Failed kidney transplant recipients benefit from a new graft as the general incident dialysis population, although additional challenges in the management of these patients are often limiting the long-term outcomes. Previously failed grafts, a long history of comorbidities, side effects of long-term immunosuppression and previous surgical interventions are common characteristics in the repeated kidney transplantation population, leading to significant complex immunological and technical aspects and often compromising the short- and long-term results. Although recipients’ factors are acknowledged to represent one of the main determinants for graft and patient survival, there is increasing interest in expanding the donor’s pool safely, particularly for high-risk candidates. The role of living kidney donation in this peculiar context of repeated kidney transplantation has not been assessed thoroughly. The aim of the present study is to analyse the effects of a high-quality graft, such as the one retrieved from living kidney donors, in the repeated kidney transplant population context. Methods: Retrospective analysis of the outcomes of the repeated kidney transplant population at our institution from 1968 to 2019. Data were extracted from a prospectively maintained database and stratified according to the number of transplants: 1st, 2nd or 3rd+. The main outcomes were graft and patient survivals, recorded from time of transplant to graft failure (return to dialysis) and censored at patient death with a functioning graft. Duration of renal replacement therapy was expressed as cumulative time per month. A multivariate analysis considering death-censored graft survival, decade of transplantation, recipient age, donor age, living donor, transplant number, ischaemic time, time on renal replacement therapy prior to transplant and HLA mismatch at HLA-A, -B and -DR was conducted. In the multivariate analysis of recipient survival, diabetic nephropathy as primary renal disease was also included. Results: A total of 2395 kidney transplant recipients were analysed: 2062 (83.8%) with the 1st kidney transplant, 279 (11.3%) with the 2nd graft, 46 (2.2%) with the 3rd+. Mean age of 1st kidney transplant recipients was 43.6 ± 16.3 years, versus 39.9 ± 14.4 for 2nd and 41.4 ± 11.5 for 3rd+ (p < 0.001). Aside from being younger, repeated kidney transplant patients were also more often males (p = 0.006), with a longer time spent on renal replacement therapy (p < 0.0001) and a higher degree of sensitisation, expressed as calculated reaction frequency (p < 0.001). There was also an association between multiple kidney transplants and better HLA match at transplantation (p < 0.0001). A difference in death-censored graft survival by number of transplants was seen, with a median graft survival of 328 months for recipients of the 1st transplant, 209 months for the 2nd and 150 months for the 3rd+ (p = 0.038). The same difference was seen in deceased donor kidneys (p = 0.048), but not in grafts from living donors (p = 0.2). Patient survival was comparable between the three groups (p = 0.59). Conclusions: In the attempt to expand the organ donor pool, particular attention should be reserved to high complex recipients, such as the repeated kidney transplant population. In this peculiar context, the quality of the donor has been shown to represent a main determinant for graft survival—in fact, kidney retrieved from living donors provide comparable outcomes to those from single-graft recipients.

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The Effect of Donors’ Demographic Characteristics in Renal Function Post-Living Kidney Donation. Analysis of a UK Single Centre Cohort

Cited by 24 publications

References 30 publications

The ageing kidney: Molecular mechanisms and clinical implications

The ageing kidney: Molecular mechanisms and clinical implications

Prevalence, Mechanisms, Treatment, and Complications of Hypertension Postliving Kidney Donation

Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants

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