Deceased-Donor Smoking History Is Associated With Increased Recipient Mortality After Kidney Transplant: A Population-Cohort Study

Gillott, Holly; Spence, Francesca Jackson; Tahir, Sanna; Hodson, James; Nath, Jay; Sharif, Adnan

doi:10.6002/ect.2017.0198

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…Within-region heterogeneity is a center level phenomenon and not directly related to the allocation system, yet potentially results in differential access to deceased donor transplants for patients as well as creating inefficiencies in the allocation system. It is likely that regulatory factors that prioritize short-term post-transplant outcomes rather than waitlist outcomes play a role in influencing organ acceptance behavior, and center flagging by Centers for Medicare and Medicaid Services (CMS) and the SRTR has been linked to changes in practice (34,36,37). Shifting incentives to those that encourage acceptance by rewarding aggressiveness are going to be essential to improving organ utilization.…”

Section: Discussionmentioning

confidence: 99%

A Donor Utilization Index to Assess the Utilization and Discard of Deceased Donor Kidneys Perceived as High Risk

Brennan¹,

Husain²,

King³

et al. 2019

CJASN

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Background and objectives An increasing number of patients on the waitlist for a kidney transplant indicates a need to effectively utilize as many deceased donor kidneys as possible while ensuring acceptable outcomes. Assessing regional and center-level organ utilization with regards to discard can reveal regional variation in suboptimal deceased donor kidney acceptance patterns stemming from perceptions of risk.Design, setting, participants, & measurements We created a weighted donor utilization index from a logistic regression model using high-risk donor characteristics and discard rates from 113,640 deceased donor kidneys procured for transplant from 2010 to 2016, and used it to examine deceased donor kidney utilization in 182 adult transplant centers with .15 annual deceased donor kidney transplants. Linear regression and correlation were used to analyze differences in donor utilization indexes. ResultsThe donor utilization index was found to significantly vary by Organ Procurement and Transplantation Network region (P,0.001), revealing geographic trends in kidney utilization. When investigating reasons for this disparity, there was no significant correlation between center volume and donor utilization index, but the percentage of deceased donor kidneys imported from other regions was significantly associated with donor utilization for all centers (rho=0.39; P,0.001). This correlation was found to be particularly strong for region 4 (rho=0.83; P=0.001) and region 9 (rho=0.82; P=0.001). Additionally, 25th percentile time to transplant was weakly associated with the donor utilization index (R 2 =0.15; P=0.03).Conclusions There is marked center-level variation in the use of deceased donor kidneys with less desirable characteristics both within and between regions. Broader utilization was significantly associated with shorter time to transplantation.

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Section: Discussionmentioning

confidence: 99%

A Donor Utilization Index to Assess the Utilization and Discard of Deceased Donor Kidneys Perceived as High Risk

Brennan¹,

Husain²,

King³

et al. 2019

CJASN

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“…Later, Gillott et al carried out a registry analysis (United Kingdom Transplant Registry, including patients from 2001 to 2013) and confirmed increased recipient mortality in a cohort receiving DS grafts (HR = 1.12, p = 0.044). However, no effect on graft survival was observed [ 11 ]. Thus, DS might affect patient-related outcomes more frequently than kidney allograft function and consequently graft survival.…”

Section: Discussionmentioning

confidence: 99%

“…While cigarette smoking in KTX recipients impairs patient and graft survival and long-term functional outcomes [7,9], data for kidney recipients who received a graft from a smoking donor is still limited. Only a few studies have investigated the impact of DS in KTX and have reported inconsistent results regarding graft and recipient survival [10][11][12][13]. Of interest, none of these studies were conducted within the Eurotransplant (ET) region, solely used brain-dead donors, or included patients from the last decade.…”

Section: Introductionmentioning

confidence: 99%

Effect of Donor Cigarette Smoking in Kidney Transplantation: Re-Evaluation of Long-Term Outcomes

Becker,

Pollmann,

Funke-Kaiser

et al. 2024

Transpl Int

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Cigarette smoking is a common risk factor associated with negative long-term outcomes in kidney transplant recipients. However, whether donor smoking decreases graft longevity or negatively impacts recipient survival after kidney transplantation remains unknown. Therefore, this study aims to investigate the long-term outcome in patients who received a kidney graft from a deceased smoking or non-smoking donor. A total of 580 patients were divided into two groups: patients who received a graft from a smoking donor (n = 276) and those who received a graft from a non-smoking donor (n = 304). Analysis of demographic factors showed that the non-smoking cohort was older, had more extended criteria donors and longer warm ischemia times. The primary composite endpoint of patient and graft survival was better in the smoking donor cohort when analyzed using Kaplan-Meier method but not when controlled for covariates in multivariate analyses. These findings do not support a previously reported negative impact of deceased donor smoking on kidney transplant recipients. Thus, the underlying results should not be interpreted in favor of a positive donor smoking history, but rather remind the transplant community that donor smoking should not be considered as a deciding factor in refusing an otherwise acceptable kidney graft.

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“…Lin et al explored data from the United States between 1994–1999 and observed smoking history among deceased kidney donors was associated with increased transplant recipient risk for death and graft loss ( 69 ). However, Gillott et al explored data from the United Kingdom between 2001–2013 and observed no association between donor smoking and allograft survival for kidney transplant recipients, although an association with mortality was observed (adjusted HR 1.16, 95% CI 1.03–1.29, p = 0.011) ( 70 ).…”

Section: Donor Clinical Factorsmentioning

confidence: 99%

Deceased Donor Characteristics and Kidney Transplant Outcomes

Sharif

2022

Transpl Int

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Kidney transplantation is the therapy of choice for people living with kidney failure who are suitable for surgery. However, the disparity between supply versus demand for organs means many either die or are removed from the waiting-list before receiving a kidney allograft. Reducing unnecessary discard of deceased donor kidneys is important to maximize utilization of a scarce and valuable resource but requires nuanced decision-making. Accepting kidneys from deceased donors with heterogenous characteristics for waitlisted kidney transplant candidates, often in the context of time-pressured decision-making, requires an understanding of the association between donor characteristics and kidney transplant outcomes. Deceased donor clinical factors can impact patient and/or kidney allograft survival but risk-versus-benefit deliberation must be balanced against the morbidity and mortality associated with remaining on the waiting-list. In this article, the association between deceased kidney donor characteristics and post kidney transplant outcomes for the recipient are reviewed. While translating this evidence to individual kidney transplant candidates is a challenge, emerging strategies to improve this process will be discussed. Fundamentally, tools and guidelines to inform decision-making when considering deceased donor kidney offers will be valuable to both professionals and patients.

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Deceased-Donor Smoking History Is Associated With Increased Recipient Mortality After Kidney Transplant: A Population-Cohort Study

Cited by 5 publications

References 25 publications

A Donor Utilization Index to Assess the Utilization and Discard of Deceased Donor Kidneys Perceived as High Risk

A Donor Utilization Index to Assess the Utilization and Discard of Deceased Donor Kidneys Perceived as High Risk

Effect of Donor Cigarette Smoking in Kidney Transplantation: Re-Evaluation of Long-Term Outcomes

Deceased Donor Characteristics and Kidney Transplant Outcomes

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