Effect of Cold Ischemic Time and HLA Matching in Kidneys Coming from ???Young??? and ???Old??? Donors

Asderakis, Argiris; Dyer, Phil; Augustine, Titus; Worthington, Judith; Campbell, Babatunde; Johnson, Robert W.

doi:10.1097/00007890-200108270-00020

Cited by 57 publications

(37 citation statements)

References 14 publications

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“…Recent data from Europe suggest that age matching for older donors and recipients results in outcomes comparable to HLA matching [157]. Avoiding extended ischemia time had a greater impact on outcome than avoiding DR mismatches [158].…”

Section: Expanded Criteria Donorsmentioning

confidence: 97%

HLA matching for kidney transplantation

et al. 2004

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Section: Expanded Criteria Donorsmentioning

confidence: 97%

HLA matching for kidney transplantation

et al. 2004

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“…This has been thought to be secondary to the lower nephron mass, the presence of hypertension and the lower creatinine clearance seen with older kidneys (8,16). Minimizing cold ischemia time with older kidneys will reduce delayed graft function, and sharing such kidneys to optimize HLA matching has been suggested to benefit graft survival (14). Thus it is important to optimize transplant outcome from older donors.…”

Section: Hla Matching and Race In Renal Transplantationmentioning

confidence: 99%

“…The beneficial effect of HLA matching has resulted in a uniform policy to share kidneys between transplant centers. Minimizing cold ischemia time and delayed graft function have been suggested to improve graft survival (14). Thus, there is a balance between increasing HLA matching and minimizing cold ischemia time which will optimize transplant outcome.…”

mentioning

confidence: 99%

A Comparison Between Recipients Receiving Matched Kidney and Those Receiving Mismatched Kidney from the Same Cadaver Donor

Bresnahan

Johnson

McIntosh³

et al. 2002

American Journal of Transplantation

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The optimal allocation of cadaveric kidneys for transplantation with reference to human leukocyte antigen (HLA) match and sharing these organs to a distant center remains controversial. The current analysis was performed using the United Network for Organ Sharing (UNOS) database for cadaveric kidney transplants (Tx) between 1988 and 1997. The graft survivals of zero-mismatch (matched) kidneys with the mate (mismatched) kidneys were compared. There were 2385 donors and 4770 Tx. Significant differences in recipient demographics between matched and mismatched Tx were: fewer African-American race (AA) in the matched group (9.0% vs. 21.9%), higher number of previous Tx (25.5% vs. 14.8%) and elevated mean cold ischemia time (24.0 vs. 22.2 h). Post-Tx dialysis requirements were similar (22.8% vs. 24.1%, p Ω0.62) and matched kidneys had to travel more distance (920 vs. 232 miles). Using a Cox model, the matched group had a decreased relative hazard of graft failure of 23.0% (p Ω0.0002) or 35% (p ∞0.0001) with and without censoring for death. There was significantly better graft survival in the matched recipients in all pairs except AA (matched) and non-AA (mismatched). For older donors (Ն 50 years, n Ω 1508), the matched grafts survival was marginally significant (p Ω0.05). Matched kidneys have improved survival compared with the mismatched kidneys despite the longer distance traveled. The benefit of mismatched transplants was predominantly seen in non-AA.

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“…Kidneys from older donors have been shown to be particularly susceptible to the negative impact of long cold ischemic time [48][49][50][51], which may contribute to the ultimate discard of the kidney. Cold ischemia time is a well-known independent risk factor for delayed graft function (DGF), which is associated with inferior graft survival [52][53][54][55].…”

Section: The Marginal Kidneymentioning

confidence: 99%

Expanded Criteria Donors in Kidney Transplantation: The Role of Older Donors in a Setting of Older Recipients

Rosa

Muscogiuri

Sarno

2013

ISRN Transplantation

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Kidney transplantation (KT) is the therapy of choice for end-stage renal disease (ESRD). The ESRD population is aging and so are patients waiting for KT. New strategies have been made for increasing the donor and recipient pools, and as a consequence kidneys from older donors or donors with significant comorbidities, the so-called "expanded criteria donor" (ECD) kidneys, are used for transplantation. Although good outcomes have been achieved from ECD, several issues are still waiting for clarification and need to be discussed. The concept of age matching is accepted as a method to ameliorate utilization of these allografts, but an optimal and widely accepted strategy is still not defined. The development of machine perfusion and the dual kidney transplantation are techniques which further improve the outcome of transplants from ECD, but the described experiences are scarce or coming from small single institutional reports. Also due to age-related immune dysfunction and associated comorbidities, the elderly recipients are more susceptible to immunosuppression related complications (e.g., infections and malignancy), although a widely accepted and validated immunosuppressive regimen is still lacking. In this paper, we review the issues related to KT employing allografts from marginal donors with a particular interest for the elderly patients.

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Effect of Cold Ischemic Time and HLA Matching in Kidneys Coming from ???Young??? and ???Old??? Donors

Abstract: Forming local alliances (common recipient lists) and minimizing delays within the hospital might reduce CIT and DGF while achieving excellent HLA matching. This should improve significantly the outcome of both old and young donor kidney grafts.

Cited by 57 publications

References 14 publications

HLA matching for kidney transplantation

HLA matching for kidney transplantation

A Comparison Between Recipients Receiving Matched Kidney and Those Receiving Mismatched Kidney from the Same Cadaver Donor

Expanded Criteria Donors in Kidney Transplantation: The Role of Older Donors in a Setting of Older Recipients

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