The global role of kidney transplantation

Garcia, G.A.; Harden, Paul; Chapman, Jeremy R.

doi:10.1097/mot.0b013e328354c277

Cited by 33 publications

(34 citation statements)

References 17 publications

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“…The rate of readmission was, however, higher than for younger recipients and this may have implications for healthcare planning and service delivery of renal transplantation in the future, with additional hospital beds and resources allocated to post-transplantation care of older renal transplant recipients. Nevertheless the quality of life and economic benefits of transplantation over dialysis (which generally involves frequent hospital attendance [14,15]) are well recognised and will likely result in overall reduction in healthcare costs for these patients. Mortality rate was higher in older transplant recipients, reflecting the expected increased mortality in this group.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following renal transplantation in older people: a retrospective cohort study

et al. 2013

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BackgroundThe mean age of renal transplant recipients is rising, with age no longer considered a contraindication. Outcomes in older patients have not, however, been fully defined. The aim of our study is to evaluate outcomes in older people following renal transplantation at a Scottish regional transplant unit.MethodsAll renal transplants from January 2001 to December 2010 were analysed (n = 762). Outcomes following renal transplantation in people over 65 years old were compared to those in younger patients. Outcome measures were: delayed graft function (DGF), primary non-function (PNF), biopsy proven acute rejection (BPAR), serum creatinine at 1 year and graft and recipient survival. Lengths of initial hospital stay and re-admission rates were also assessed. Student’s T-Test was used to analyse continuous variables, Pearson’s Chi-Squared test for categorical variables and the Kaplan-Meier estimator for survival analysis.ResultsOlder recipients received proportionately more kidneys from older donors (27.1% vs. 6.3%; p < 0.001). Such kidneys were more likely to have DGF (40.7% vs. 16.9%; p < 0.001). Graft loss at 1 year was higher in kidneys from older donors (15.3% vs. 7.6%; p = 0.04). There was no significant difference in patient survival at 1 year based on the age of the donor kidney. Recipient age did not affect DGF (16.9% vs. 18.5%; p = 0.77) or graft loss at 1 year (11.9% vs. 7.8%; p = 0.28). Older recipients were, however, more likely to die in the first year post transplant (6.8% vs. 2.1%; p = 0.03). BPAR was less common in older patients (6.8% vs. 22%; p < 0.01). Older recipients were more likely to be readmitted to hospital (31.8% vs. 10.9%; p < 0.001).ConclusionsOlder patients experience good outcomes following renal transplantation and donor or recipient age alone should not preclude this treatment. An awareness of this in clinicians managing older patients is important since the prevalence of End Stage Renal Disease is increasing in this age group.

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Section: Discussionmentioning

confidence: 99%

Outcomes following renal transplantation in older people: a retrospective cohort study

et al. 2013

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“…Kidney transplantation (KT) is a therapy for end‐stage kidney disease that can improve the quality and quantity of life 8 . The number of KT procedures and the survival of transplant recipients are increasing 9 .…”

Section: Introductionmentioning

confidence: 99%

Hepatitis B reactivation after kidney transplantation in hepatitis B surface antigen‐negative, core antibody‐positive recipients

Kim

Chung

Sinn

et al. 2020

Journal of Viral Hepatitis

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Nowadays, intensive immunosuppressive therapy including rituximab is commonly used prior to kidney transplantation (KT), raising concerns over hepatitis B virus (HBV) reactivation among hepatitis B surface antigen (HBsAg)‐negative and anti‐hepatitis B core (HBc)‐positive KT recipients. Recent practice guidelines suggested watchful monitoring or antiviral prophylaxis for the first 6‐12 months, the period of maximal immunosuppression. However, the actual risk for HBV reactivation, and whether short‐term antiviral therapy in the early period is necessary, remains unclear. A total of 449 HBsAg‐negative and anti‐HBc‐positive KT recipients were analysed for HBV reactivation. During a median follow‐up of 6.7 (interquartile range: 4.2‐9.4) years, HBV reactivation was observed in 9 patients (2.0%). The median time of HBV reactivation from KT was 2.8 years (range: 1.4‐11.5 years), with cumulative incidence rates of 0%, 1% and 2% for 1, 3 and 5 years, respectively. There were no severe adverse outcomes, including liver transplantation or mortality related to HBV reactivation. The risk of HBV reactivation was not high, even in anti‐HBs‐negative patients (n = 60, 4% at 5 years), ABO mismatch (n = 92, 4% at 5 years), use of rituximab (n = 66, 3% at 5 years) or plasmapheresis (n = 17, 7% at 5 years), and acute rejection (n = 169, 3% at 5 years). In conclusion, the HBV reactivation risk was not high and the time of detection was not clustered in the early post‐KT period. Our findings favour continued watchful monitoring over antiviral prophylaxis in the early period.

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“…Renal transplantation is widely recognized as the treatment of choice for end‐stage renal disease (ESRD) in both children and adults. It is associated with improved survival, better quality of life , and superior long‐term cost effectiveness compared with patients who remain on dialysis .…”

Section: Introductionmentioning

confidence: 99%

Gender Disparities in Access to Pediatric Renal Transplantation in Europe: Data From the ESPN/ERA‐EDTA Registry

Hogan

Couchoud

Bonthuis³

et al. 2016

American Journal of Transplantation

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Inequalities between genders in access to transplantation have been demonstrated. We aimed to validate this gender inequality in a large pediatric population and to investigate its causes. This cohort study included 6454 patients starting renal replacement therapy before 18 years old, in 35 countries participating in the European Society for Paediatric Nephrology/European Renal Association–European Dialysis and Transplant Association Registry. We used cumulative incidence competing risk and proportional hazards frailty models to study the time to receive a transplant and hierarchical logistic regression to investigate access to preemptive transplantation. Girls had a slower access to renal transplantation because of a 23% lower probability of receiving preemptive transplantation. We found a longer follow‐up time before renal replacement therapy in boys compared with girls despite a similar estimated glomerular filtration rate at first appointment. Girls tend to progress faster toward end‐stage renal disease than boys, which may contribute to a shorter time available for pretransplantation workup. Overall, medical factors explained only 70% of the gender difference. In Europe, girls have less access to preemptive transplantation for reasons that are only partially related to medical factors. Nonmedical factors such as patient motivation and parent and physician attitudes toward transplantation and organ donation may contribute to this inequality. Our study should raise awareness for the management of girls with renal diseases.

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The global role of kidney transplantation

Cited by 33 publications

References 17 publications

Outcomes following renal transplantation in older people: a retrospective cohort study

Outcomes following renal transplantation in older people: a retrospective cohort study

Hepatitis B reactivation after kidney transplantation in hepatitis B surface antigen‐negative, core antibody‐positive recipients

Gender Disparities in Access to Pediatric Renal Transplantation in Europe: Data From the ESPN/ERA‐EDTA Registry

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