High-Urgency Renal Transplantation: Indications and Long-Term Outcomes

Abstract

The concept of high-urgency (HU) renal transplantation was introduced in order to offer to patients, who are not able to undergo long-term dialysis treatment, a suitable renal graft in a short period of time, overcoming by this way the obstacle of the prolonged time spent on the waiting list. The goal of this study was to evaluate the patient and graft survivals after HU renal transplantation and compare them to the long-term outcomes of the non-high-urgency renal transplant recipients. The clinical course of 33 HU renal transplant recipients operated on at our center between 1995 and 2010 was retrospectively analyzed. The major indication for the HU renal transplantation was the imminent lack of access for either hemodialysis or peritoneal dialysis (67%). The patient survival of the study population was 67%, 56%, and 56%, whereas the graft survival was 47%, 35% and 35%, at 5, 10, and 15 years, respectively. In the comparison between our study population and the non-HU renal transplant recipients, our study population presented statistically significant (P < 0.05) lower patient survival rates. The HU renal transplant recipients also presented lower graft survival rates, but statistical significance (P < 0.05) was reached only in the 5-year graft survival rate.

Risk-Adjusted Analysis of Relevant Outcome Drivers for Patients after More Than Two Kidney Transplants

“…As the statistical analysis showed that the number of previous renal transplantations had no effect on patient survival and because of the small number of patients after fourth ( n = 9) and fifth ( n = 3) renal transplantation, patient survival for the subgroups of patients was not analyzed. The patient survival rates mentioned above correlate with the results presented by almost all of the actual studies [ 16 , 19 – 21 ] and they do not differ significantly from the overall patient survival rates after renal transplantation as presented in our previous study [ 22 ]. Regarding the factors that could influence the survival of the renal transplant recipients, the univariate analysis of our data showed that only age in years at the time of the last transplantation and the number of surgical complications after the last transplant had a significant influence on patient survival during follow-up.…”

Clinical Characteristics and Outcomes of Kidney Transplantation under Urgency Priority Condition

“…Worse outcomes in UP KT patients were consistently previously reported [2,4,7,8]. In our cohort, UP status was as independent risk factor for graft loss, which should be related to vascular status, since onethird of graft losses occurred due to vascular thrombosis.…”

“…Given the above considerations, we understand that it is not possible to compare the prevalence of UP KT in this cohort with reports from other regions whose allocation criteria and socio-demographic profile are different: 0.019% in Turkey [2], 0.96% in Colone, Germany [8], 1.1% in Hanover, Germany [4], 1.7% in Porto, Portugal [6], 2.1% in Eurotransplant area [7], and 3.2% in Rio Grande do Sul, Brazil [3]. We speculate that this high prevalence is a consequence of the inadequate access to health systems, low-quality vascular accesses for long periods (short or long term dialysis catheters), low access to PD and long period on dialysis off WL.…”

The Last Exit Before the Bridge: Atrial Permanent Catheter Placement for Hemodialysis Access

“…The patient's lower extremity veins were not suitable for ensuring vascular access due to thrombosis of the vena cava inferior. The urgent cadaveric renal transplantation was introduced in order to offer patients with an imminent lack of access for either hemodialysis or peritoneal dialysis and the inability of the patient to cope with dialysis with a high risk for suicide (9). This option was not considered for this patient according to consultation of the transplant surgeon.…”