Access to renal transplantation for the elderly in the face of new allocation policy: A review of contemporary perspectives on “older” issues

Tso, Paul L.

doi:10.1016/j.trre.2013.10.002

Cited by 30 publications

(27 citation statements)

References 50 publications

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“…Kidney transplant candidates are becoming older and more medically complex [1, 2]. Better objective methods of identifying candidates at high-risk of post-transplant morbidity are needed.…”

Section: Introductionmentioning

confidence: 99%

Relationship between pre-transplant physical function and outcomes after kidney transplant

et al. 2017

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Background Performance-based measures of physical function predict morbidity following non-transplant surgery. Study objectives were to determine whether physical function predicts outcomes after kidney transplant and assess how physical function changes post-transplant. Methods We conducted a prospective study involving living donor kidney transplants recipients at our center 5/2012 to 2/2014. Physical function was measured using the Short Physical Performance Battery (SPPB) (balance, chair stands, gait speed) and grip strength testing. Initial length of stay (LOS), 30-day rehospitalizations, allograft function and quality of life (QOL) were assessed. Results The majority of the 140 patients in our cohort had excellent pre-transplant physical function. In general, balance scores were more predictive of post-transplant outcomes than the SPPB. Decreased pre-transplant balance was independently associated with longer LOS and increased rehospitalizations but not with post-transplant QOL. 35% of patients experienced a clinically meaningful (≥ 1.0 m/s) improvement in gait speed four months post-transplant. Conclusions Decreased physical function may be associated with longer LOS and rehospitalizations following kidney transplant. Further studies are needed to confirm this association. The lack of relationship between pre-transplant gait speed and outcomes in our cohort may represent a ceiling effect. More comprehensive measures, including balance testing, may be required for risk stratification.

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“…Kidney transplant candidates are becoming older and more medically complex [1, 2]. Better objective methods of identifying candidates at high-risk of post-transplant morbidity are needed.…”

Section: Introductionmentioning

confidence: 99%

Relationship between pre-transplant physical function and outcomes after kidney transplant

et al. 2017

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“…As a move towards more effective organ utilization, the Organ Procurement and Transplantation Network (OPTN) modified the organ allocation system in 2014 to better match allograft and recipient longevity and to expand the offer of marginal kidneys regionally to minimize cold ischemia time and improve their viability (1). As part of this system, all kidneys from deceased donors are now given a Kidney Donor Risk Index (KDRI), which is calculated from 14 donor and transplant characteristics and represents the risk (hazard ratio, HR) of allograft failure compared with a kidney from an “average” deceased donor between 1995 and 2005 (2).…”

Section: Introductionmentioning

confidence: 99%

Utility of Applying Quality Assessment Tools for Kidneys With KDPI ≥80

et al. 2017

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Background Kidneys with “high” kidney donor profile index (KDPI) are often biopsied and pumped, yet frequently discarded. Methods In this multicenter study, we describe the characteristics and outcomes of kidneys with KDPI ≥80 that were procured from 338 deceased donors. We excluded donors with anatomical kidney abnormalities. Results Donors were categorized by the number of kidneys discarded: 1) none (n=154, 46%), 2) 1 discarded and 1 transplanted (n=48, 14%), 3) both discarded (n=136, 40%). Donors in group 3 were older, more often white, and had higher terminal creatinine and KDPI than group 1 (all p<0.05). Biopsy was performed in 92% of all kidneys, and 47% were pumped. Discard was associated with biopsy findings and 1st hour renal resistance. Kidney injury biomarker levels (NGAL, IL-18, and KIM-1 measured from donor urine at procurement and from perfusate soon after pump perfusion) were not different between groups. There was no significant difference in 1-year estimated glomerular filtration rate (eGFR) or graft failure between groups 1 and 2 (41.5±18 vs. 41.4±22 mL/min/1.73m2; p=0.97 and 9% vs. 10%; p=0.76). Conclusions Kidneys with KDPI ≥80 comprise the most resource consuming fraction of our donor kidney pool and have the highest rates of discard. Our data suggest that some discarded kidneys with KDPI ≥80 are viable; however, current tools and urine- and perfusate-biomarkers to identify these viable kidneys are not satisfactory. We need better methods to assess viability of kidneys with high KDPI.

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“…Major determinants of discard rates are biopsy findings on wedge biopsy (percent glomerulosclerosis) and parameters of machine pump perfusion (5). The United Network of Organ Sharing (UNOS) Kidney Transplantation Committee has recently approved a new allocation policy, that will be implemented by the end of 2014 (6), which is based on the kidney donor risk index (KDRI), that represents the relative risk of post-transplant graft failure from a particular deceased donor compared to the average donor (7). The KDPI is an additional numerical score, which results from ranking KDRI from the 1 st to the 100 th percentile, with reference to a given Organ Procurement and Transplantation Network (OPTN) donor cohort.…”

Section: Introductionmentioning

confidence: 99%

The Kidney Donor Profile Index (KDPI) of Marginal Donors Allocated by Standardized Pretransplant Donor Biopsy Assessment: Distribution and Association With Graft Outcomes

Gandolfini

Buzio

Zanelli

et al. 2014

American Journal of Transplantation

111

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Pre-transplant donor biopsy (PTDB)-based marginal-donor allocation systems to single or dual renal transplantation could increase the use of organs with Kidney Donor Profile Index (KDPI) in the highest range (e.g. >80 or >90), whose discard rate approximates 50% in the US. To test this hypothesis, we retrospectively calculated the KDPI and analyzed the outcomes of 442 marginal kidney transplants (340 single transplants: 278 with a PTDB Remuzzi score <4 [median KDPI:87; interquartile range(IQR):78-94] and 62 with a score =4 [median KDPI:87; IQR:76-93]; 102 dual transplants [median KDPI: 93; IQR:86-96]) and 248 single standard transplant controls [median KDPI:36; IQR:18-51]. PTDB-based allocation of marginal grafts led to a limited discard rate of 15% for kidneys with KDPI of 80-90 and of 37% for kidneys with a KDPI of 91-100. Although 1-year eGFRs were significantly lower in recipients of marginal kidneys (-9.3, -17.9, and -18.8ml/min, for dual transplants, single kidneys with PTDB score <4, and =4, respectively; P<0.001), graft survival (median follow-up 3.3 years) was similar between marginal and standard kidney transplants (hazard ratio: 1.20 [95% confidence interval: 0.80 to 1.79; P=0.38]). In conclusion, PTDB-based allocation allows the safe transplantation of kidneys with KDPI in the highest range that may otherwise be discarded.

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Access to renal transplantation for the elderly in the face of new allocation policy: A review of contemporary perspectives on “older” issues

Cited by 30 publications

References 50 publications

Relationship between pre-transplant physical function and outcomes after kidney transplant

Relationship between pre-transplant physical function and outcomes after kidney transplant

Utility of Applying Quality Assessment Tools for Kidneys With KDPI ≥80

The Kidney Donor Profile Index (KDPI) of Marginal Donors Allocated by Standardized Pretransplant Donor Biopsy Assessment: Distribution and Association With Graft Outcomes

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