Clinical and Histopathologic Comparative Analysis Between Kidney Transplant Recipients From Expanded-Criteria Donors and Standard-Criteria Donors

Ramalho, A.; Custódio, Fabiano Bichuette; Tokuda, Bunta; Caldas, Heloisa Cristina; Fernandes, Ida Maria Maximina; Abbud-Filho, Mário; Baptista, Maria Alice Sperto Ferreira

doi:10.1016/j.transproceed.2013.05.004

Cited by 8 publications

(11 citation statements)

References 27 publications

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“…To meet the increasing discrepancy between supply and demand, older donors and ECDs (that is, age >60 yr, or age 50–60 yr plus additional risk factors) as well as donors after cardiac death (DCD) are used for transplantation with increasing frequency . Moreover, multiple validated prediction models have been suggested as a tool of matching the estimated future survival of transplanted kidneys with that of recipients while preventing distribution of kidneys with very short potential post‐transplant survival to candidates with long life expectancy after transplantation, as well as transplantation of kidneys with long expected post‐transplant survival to candidates with a limited potential for post‐transplant survival.…”

Section: Allocation Of Ecd Kidneys To Old Recipientsmentioning

confidence: 99%

Clinical issues in renal transplantation in the elderly

Hod

Goldfarb–Rumyantzev

2015

Clinical Transplantation

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Kidney transplantation is the best renal replacement therapy option and is superior to dialysis in elderly end-stage renal disease (ESRD) patients. Furthermore, the outcome of transplantation in the elderly is comparable to younger patients in terms of allograft survival. The exact nature of this phenomenon is not completely clear. As the elderly population continues to grow, it becomes more important to identify specific issues associated with kidney transplantation. In particular, elderly transplant recipients might have a lower chance of acute rejection as their immune systems seem to be less reactive. This might predispose elderly recipients to greater risk of post-transplant infectious complications or malignancies. Furthermore, due to differences in pharmacokinetics, elderly recipients might require lower doses of immunosuppressive medication. As the main cause of graft failure in the elderly is death with a functioning graft and also considering the scarcity of donor organs, it might make sense to recommend transplanting elderly recipients with extended criteria donor kidneys. This approach would balance shorter patient survival compared to younger recipients. In conclusion, old age should not preclude ESRD patients from kidney transplantation. However, specific differences that have to do with immunosuppression and other aspects of managing elderly transplant recipients should be considered.

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Section: Allocation Of Ecd Kidneys To Old Recipientsmentioning

confidence: 99%

Clinical issues in renal transplantation in the elderly

Hod

Goldfarb–Rumyantzev

2015

Clinical Transplantation

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“…It is associated with high rates of complications, such as rejection and infections; poorer long‐term graft survival; longer hospitalization; and higher costs . In Brazil, 50%‐80% of renal transplants from deceased donors evolve with DGF, compared with low rates reported in transplantation centers of the United States and Europe . This problem in Brazil is mainly due to long cold ischemia time (CIT), generally longer than 20 hours, and inadequate maintenance of donors after brain death diagnosis .…”

Section: Introductionmentioning

confidence: 99%

“…The maintenance of the donor after brain death diagnosis is not often possible in public intensive care units, which are often crowded and lack skilled professionals and/or dedicated staff to care for donors . In addition, following a worldwide trend, the use of donors with expanded criteria (UNOS ECD system criteria) is increasing; such use currently constitutes 20%‐30% of donors in Brazil and might contribute for the increase of DGF rate …”

Section: Introductionmentioning

confidence: 99%

“…4,9,10 In addition, following a worldwide trend, the use of donors with expanded criteria (UNOS ECD system criteria) is increasing; such use currently constitutes 20%-30% of donors in Brazil and might contribute for the increase of DGF rate. 3,6,7,11 In Brazil, long CIT depends on the logistics of donation and allocation of organs. 4 To reduce the CIT, it is necessary to optimize the…”

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confidence: 99%

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Impact of machine perfusion after long static cold storage on delayed graft function incidence and duration and time to hospital discharge

Matos

Requião-Moura

Borrelli

et al. 2017

Clinical Transplantation

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Delayed graft function (DGF) is very high in our center (70%-80%), and we usually receive a kidney for transplant after more than 22 hours of static cold ischemia time (CIT). Also, there is an inadequate care of the donors, contributing to a high rate of DGF. We decided to test whether machine perfusion (MP) after a CIT improved the outcome of our transplant patients. We analyzed the incidence of DGF, its duration, and the length of hospital stay (LOS) in patients who received a kidney preserved with MP after a CIT (hybrid perfusion-HP). We included 54 deceased donors kidneys preserved with HP transplanted from Feb/13 to Jul/14, and compared them to 101 kidney transplants preserved by static cold storage (CS) from Nov/08 to May/12. The median pumping time was 11 hours. DGF incidence was 61.1% vs 79.2% (P = .02), median DGF duration was 5 vs 11 days (P < .001), and median LOS was 13 vs 18 days (P < .011), for the HP compared to CS group. The observed reduction of DGF with machine perfusion did not occur in donors over 50 years old. In the multivariate analysis, risk factors for DGF, adjusted for CIT, were donor age (OR, 1.04; P = .005) and the absence of use of MP (OR, 1.54; P = .051). In conclusion, the use of HP contributed to faster recovery of renal function and to a shorter length of hospital stay. K E Y W O R D Sdelayed graft function, kidney (allograft) function/dysfunction, organ perfusion and preservation

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“…Because of the discrepancy between supplied organs and patients on the waiting list, which mirrors the trend in other countries, Brazil has expanded its criteria for organ acceptance. Some studies show that the rate of use of expanded criteria donors (ECDs) for kidneys in Brazil is about 17% to 27.2% . This rate is similar to the mean rate of 16.6% reported in the 2012 registry of the United Network for Organ Sharing (UNOS) …”

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confidence: 56%