When are you too old to get a kidney transplants?

Kodali, Lavanya; Turner, Alexandra P.

doi:10.1097/mnh.0000000000000548

Cited by 9 publications

(10 citation statements)

References 30 publications

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“…The effect of functional impairment is less profound for older patients than for younger patients, but the combination of older age and functional impairment is nevertheless associated with a very high risk of death or delisting. There is no definitive upper age limit for kidney transplantation, and there is a need for tools to better predict waitlist mortality for elderly patients . A metric like KPS is appropriate to convey risk to patients and could be potentially useful in counseling patients about their likelihood of surviving to transplant.…”

Section: Discussionmentioning

confidence: 99%

“…There is no definitive upper age limit for kidney transplantation, and there is a need for tools to better predict waitlist mortality for elderly patients. 42 A metric like KPS is appropriate to convey risk to patients and could be potentially useful counseling patients about their likelihood of surviving to transplant. In addition, these data highlight the potential for interventions to maintain or improve functional status such that younger and older patients remain healthy enough to receive their transplant 12 and may affect clinical decision-making for younger impaired patients and robust older patients.…”

Section: Discussionmentioning

confidence: 99%

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Association of Karnofsky Performance Status with waitlist mortality among older and younger adults awaiting kidney transplantation

Sheshadri

Cullaro

Johansen

et al. 2020

Clinical Transplantation

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Patients with end‐stage renal disease (ESRD) have impaired functional status compared with the general population. We sought to explore the association between Karnofsky Performance Status (KPS) and death/delisting from the kidney transplantation waitlist and whether this association differed by age. Patients listed for single‐organ kidney transplantation in the United Network for Organ Sharing/Organ Procurement and Transplantation Network from January 1, 2015, to January 1, 2018, were included. We performed competing‐risk regression analyses to determine the association between KPS (“Severely impaired”, “Moderately impaired”, “Non‐impaired”) and death/delisting, with deceased‐donor kidney transplantation as a competing risk. We tested for interactions between age and KPS on death/delisting. Of the 89,819 patients analyzed, 39% were impaired (KPS < 80) and 20% were aged ≥ 65 years. Older age and lower KPS were independently associated with higher risk of death/delisting (age 45‐64 years, HR 1.97 [95% CI 1.73‐2.24]; age ≥ 65 years, HR 3.62 [95% CI 3.33‐3.92] compared with age < 45 years; moderately impaired, HR 1.68 [95% CI 1.45‐1.95]; severely impaired, HR 4.80 [95% CI 3.71‐6.21] compared with non‐impaired). Lower KPS was associated with higher risk of death/delisting among all ages, but this effect was slightly less pronounced among individuals aged ≥ 65 years. Performance status should be used when counseling patients with ESRD on their risks for death/delisting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Karnofsky Performance Status with waitlist mortality among older and younger adults awaiting kidney transplantation

Sheshadri

Cullaro

Johansen

et al. 2020

Clinical Transplantation

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“…Indeed, the cumulative effect of multiple lines of therapy may potentially impact safety, particularly considering chronic treatments such as TCZ 12,13 . In addition, the continuous change in the demography of recipients toward an older age and a frail profile [14][15][16] may considerably influence the risk/benefit balance of increasing long-term immunosuppressive load. In this context avoidance of unnecessary treatments is mandatory.…”

Section: Introductionmentioning

confidence: 99%

Early effects of first‐line treatment with anti‐interleukin‐6 receptor antibody tocilizumab for chronic active antibody‐mediated rejection in kidney transplantation

Antônio

Presta

Gai

et al. 2020

Clinical Transplantation

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Introduction Chronic active antibody-mediated rejection (cAMR) is a major determinant of late allograft failure. Rituximab/immunoglobulins (IVIg) + plasma exchange (PLEX) showed controversial results in cAMR treatment. Tocilizumab (TCZ), a humanized anti-interleukin 6 receptor antibody, has been recently used as rescue therapy in patients non-responsive to rituximab/IVIg/PLEX with favorable outcomes. Whether TCZ acts "per se" or requires a priming effect from previous treatments is currently unknown.Methods 15 patients with cAMR were treated with TCZ as a first-line therapy and followed for a median time of 20.7 months.Results Despite the majority of patients experiencing advanced transplant glomerulopathy (TG) at diagnosis (60% with cg3), glomerular filtration rate and proteinuria stabilized during the followup, with a significant reduction in donor-specific antibodies. Protocol biopsies after 6 months demonstrated significant amelioration of microvascular inflammation and no TG, C4d deposition or IF/TA progression. Gene-expression and immunofluorescence analysis showed upregulation of three genes (TJP-1, AKR1C3 and CASK) involved in podocyte, mesangial and tubular restoration.Conclusion TCZ adopted as a first-line approach in cAMR was associated with early serological and histological improvements and functional stabilization even in advanced TG, suggesting a role for the use of TCZ alone with the avoidance of unnecessary previous immunosuppressants.

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“…7,8 However, in recent years, the prevalence of KT candidates with multiple comorbidities or advanced age has been increasing, and their pretransplant preparation may be complex and time-consuming. [9][10][11] Even in combined liver-kidney or heart-kidney transplantation, a delayed kidney procedure has been recently advocated, aiming at stabilizing the recipient after the first organ implant and protecting the kidney graft from hemodynamic instability. 12,13 In these settings, the extension of CIT has been usually conditioned to the use of HMP, although the safety profile of this management has not been clearly and extensively demonstrated so far.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, several reports still insist on the necessity of limiting CIT to as short as possible 7,8 . However, in recent years, the prevalence of KT candidates with multiple comorbidities or advanced age has been increasing, and their pretransplant preparation may be complex and time‐consuming 9‐11 . Even in combined liver‐kidney or heart‐kidney transplantation, a delayed kidney procedure has been recently advocated, aiming at stabilizing the recipient after the first organ implant and protecting the kidney graft from hemodynamic instability 12,13 .…”

Section: Introductionmentioning

confidence: 99%

Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function

et al. 2021

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In deceased donor kidney transplantation (KT), a prolonged cold ischemia time (CIT) is a negative prognostic factor for KT outcome, and the efficacy of hypothermic machine perfusion (HMP) in prolonging CIT without any additional hazard is highly debated. We conducted a retrospective study on a cohort of 154 single graft deceased donor KTs, in which a delayed HMP, after a preliminary period of static cold storage (SCS), was used to prolong CIT for logistic reasons. Primary outcomes were postoperative complications as well as 1 year graft survival and function. 73 cases (47.4%) were managed with HMP and planned KT, while 81 (52.6%) with SCS and urgent KT. The median CIT in HMP group and SCS group was 29 hour:57 minutes [27-31 hour:45 minutes] and 11 hour:25 minutes [9-14 hour:30 minutes], respectively (P < .001). The period of SCS in the HMP group was significantly shorter than in the SCS group (10 vs. 11 hour:25 minutes, P = .02) as well as the prevalence of expanded criteria donors was significantly higher (43.8% vs. 18.5%, P < .01). After propensity score matching for these two baseline characteristics, the HMP and SCS groups showed comparable outcomes in terms of delayed graft function, vascular, and urologic complications, infections, and episodes of graft rejection. At 1 year follow-up, serum creatinine levels were comparable between the groups. Therefore, the use of HMP to prolong the CIT and convert KT into a planned procedure seemed to have an adequate safety profile, with outcomes comparable to KT managed as an urgent procedure and a CIT nearly three time shorter. K E Y W O R D Scold ischemia time, delayed graft function, hypothermic machine perfusion, kidney transplant morbidity, kidney transplantation How to cite this article: Adani GL, Pravisani R, Tulissi P, et al. Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function.

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When are you too old to get a kidney transplants?

Cited by 9 publications

References 30 publications

Association of Karnofsky Performance Status with waitlist mortality among older and younger adults awaiting kidney transplantation

Association of Karnofsky Performance Status with waitlist mortality among older and younger adults awaiting kidney transplantation

Early effects of first‐line treatment with anti‐interleukin‐6 receptor antibody tocilizumab for chronic active antibody‐mediated rejection in kidney transplantation

Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function

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