The Need for New Donor Stratification to Predict Graft Survival in Deceased Donor Kidney Transplantation

Abstract

PurposeThe aim of this study was to determine whether stratification of deceased donors by the United Network for Organ Sharing (UNOS) criteria negatively impacts graft survival.Materials and MethodsWe retrospectively reviewed deceased donor and recipient pretransplant variables of kidney transplantations that occurred between February 1995 and December 2009. We compared clinical outcomes between standard criteria donors (SCDs) and expanded criteria donors (ECDs).ResultsThe deceased donors consisted of 369 patients. A total of 494 transplant recipients were enrolled in this study. Mean age was 41.7±11.4 year (range 18–69) and 273 patients (55.4%) were male. Mean duration of follow-up was 8.8±4.9 years. The recipients from ECD kidneys were 63 patients (12.8%). The overall mean cold ischemia time was 5.7±3.2 hours. Estimated glomerular filtration rate at 1, 2, and 3 years after transplantation were significantly lower in ECD transplants (1 year, 62.2±17.6 vs. 51.0±16.4, p<0.001; 2 year, 62.2±17.6 vs. 51.0±16.4, p=0.001; 3 year, 60.9±23.5 vs. 54.1±18.7, p=0.047). In multivariate analysis, donor age (≥40 years) was an independent risk factor for graft failure. In Kaplan-Meier analyses, there was no significant difference in death-censored graft survival (Log rank test, p>0.05), although patient survival was lower in ECDs than SCDs (Log rank test, p=0.011).ConclusionOur data demonstrate that stratification by the UNOS criteria does not predict graft survival. In order to expand the donor pool, new criteria for standard/expanded donors need to be modified by regional differences.

Comparison of kidney allograft survival in the Eurotransplant senior program after changing the allocation criteria in 2010—A single center experience

“…They might be influenced by different factors including recipients' and donors' age, CIT, HLA mismatch and dialysis vintage [26,27]. A major concern of the ESP was, therefore, that elderly recipients not only have to cope with the effects of their own age, but also experience disadvantages from the elderly graft as recipients' and donors' age has been shown to be a risk factor for death, perioperative and peri-transplantation complications [28][29][30][31][32][33][34]. Heldal et al more specifically identified donors' age �60 years as a predictor for increased mortality and graft loss in the elderly [35].…”

“…Graft function and survival are influenced by the dialysis vintage and the associated comorbidities [ 4 , 19 , 29 , 30 , 32 , 33 , 39 ]. Quick transplantation of an ECD graft and shorter dialysis vintage seem to outweigh the benefits of a younger graft despite a longer dialysis vintage [ 10 ].…”

“…Even though DR mismatches did not increase in the nESPC at MTC, Dreyer et al's suggestions need to be considered as better DR matching can potentially further improve the outcome after KTx [14]. It should be noted that only one patient in the nESPC [4,19,29,30,32,33,39]. Quick transplantation of an ECD graft and shorter dialysis vintage seem to outweigh the benefits of a younger graft despite a longer dialysis vintage [10].…”

Donation and transplantation of organs and tissues: a dilemma about procedural interferences / Doação e transplantes de órgãos e tecidos: um dilema acerca das interferências processuais / Donación y trasplantes de órganos y tejidos: un dilema..

“…Em todo o transcurso até a doação efetiva outras questões éticas podem surgir, dentre elas o questionamento a respeito do destino do órgão ou da identidade dos familiares do doador, seja por curiosidade, desejo de expressar gratidão ou até mesmo como forma de ter ao alcance uma parte do ente querido; essa constitui uma situação que exige ética por parte do profissional que precisa manter sigilo, visto o perigo que tal informação possa representar para o cotidiano de uma ou de ambas as partes. Como a autorização familiar é prevista em lei, outra questão que se enquadra nos preceitos éticos é a não retirada de órgãos em pacientes sem identificação, uma vez que, se a família não puder autorizar, o processo não ocorre (18) .…”

Success of kidney transplantations from deceased donors with acute kidney injury

“…The severe shortage of organs available for standard transplantation has led to an increase in living-donor kidney transplants on the one hand, and increased acceptance of marginal donor organs on the other. Feasible marginal donor strategies include the use of double-kidney transplants, including organs from elderly donors with an already reduced renal function [8,9], or the transplantation of organs derived from expanded criteria donors (ECDs) [10–12]. In addition, the transplantation of organs from donors with a history of acute kidney injury (AKI) is also possible, and is increasingly utilized [13].…”