Live donor kidney transplantation. Situation analysis and roadmap

Valentín, María de la Oliva; Hernández, Domingo; Crespo, Marta; Mahíllo, Beatriz; Beneyto, Isabel; Martínez, Ignacio Martínez; Kanter, Julia; Calderari, Elena; Gil-Vernet, S.; Sánchez, Samuel Sánchez; Agüera, María Luisa; Bernal, Gabriel; Santiago, Carlos; Díaz‐Corte, Carmen; Díaz, Cándido; Espinosa, Laura; Facundo, Carme; Fernández-Lucas, Milagros; Ferreiro, Tamara; García-Erauzkin, Gorka; García-Álvarez, Teresa; Fraile, Pilar Quijada; González-Rinne, Ana; Gonzalez-Soriano, M. J.; González, Esther; Gutiérrez-Dalmau, Álex; Jiménez, Carlos; Lauzurica, Ricardo; Lorenzo, Inmaculada; Martín-Moreno, Paloma Leticia; Moreso, Francesc; Gracia, M.C. de; Pérez‐Flores, Isabel; Ramos-Verde, Ana; Revuelta, Ignacio; Rodríguez-Ferrero, María Luisa; Ruiz, Juan Carlos; Sánchez‐Sobrino, Beatriz; Domínguez‐Gil, Beatriz

doi:10.1016/j.nefroe.2022.02.002

Cited by 4 publications

(2 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This takes us into the field of patients' needs, which are closely related to their caregivers' needs and are becoming ever more specific due to the aforementioned complexities. It has thus been established that adequate staffing is essential to high-quality care, satisfaction with the care received, and shorter waiting times in populations defined as complex [46,47].…”

Section: Discussionmentioning

confidence: 99%

Complex management and descriptive cost analysis of kidney transplant candidates: a descriptive cross-sectional study

Pedreira-Robles,

Garcimartín,

Pérez-Sáez

et al. 2024

BMC Health Serv Res

View full text Add to dashboard Cite

Background The organisational care needs involved in accessing kidney transplant have not been described in the literature and therefore a detailed analysis thereof could help to establish a framework (including appropriate timing, investment, and costs) for the management of this population. The main objective of this study is to analyse the profile and care needs of kidney transplant candidates in a tertiary hospital and the direct costs of studying them. Methods A descriptive, cross-sectional study was conducted using data on a range of variables (sociodemographic and clinical characteristics, study duration, and investment in visits and supplementary tests) from 489 kidney transplant candidates evaluated in 2020. Results The comorbidity index was high (> 4 in 64.3%), with a mean of 5.6 ± 2.4. Part of the study population had certain characteristics that could hinder their access a kidney transplant: physical dependence (9.4%), emotional distress (33.5%), non-adherent behaviours (25.2%), or language barriers (9.4%). The median study duration was 6.6[3.4;14] months. The ratio of required visits to patients was 5.97:1, meaning an investment of €237.10 per patient, and the ratio of supplementary tests to patients was 3.5:1, meaning an investment of €402.96 per patient. Conclusions The study population can be characterised as complex due to their profile and their investment in terms of time, visits, supplementary tests, and direct costs. Management based on our results involves designing work-adaptation strategies to the needs of the study population, which can lead to increased patient satisfaction, shorter waiting times, and reduced costs.

show abstract

Section: Discussionmentioning

confidence: 99%

Complex management and descriptive cost analysis of kidney transplant candidates: a descriptive cross-sectional study

Pedreira-Robles,

Garcimartín,

Pérez-Sáez

et al. 2024

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…In terms of both patient and graft survival, living‐donor kidney transplantation is considered the best available treatment for end‐stage renal disease [1]. Ratner and colleagues performed the first laparoscopic living‐donor nephrectomy (LLDN) in 1995 [2].…”

Section: Introductionmentioning

confidence: 99%

Vascular closure devices in living‐donor nephrectomy: a much‐needed systematic review and meta‐analysis focusing on safety

et al. 2023

View full text Add to dashboard Cite

ObjectiveTo assess the safety of vascular closure devices in living‐donor nephrectomy (LDN), as staplers and non‐transfixion techniques (polymer locking and metal clips) are the methods employed to secure the renal vessels during laparoscopic and robotic LDN, but the use of clips has come into question since the United States Food and Drug Administration and manufacturers issued a contraindication.MethodsA systematic review and meta‐analysis were conducted to assess the safety of vascular closure devices (International Prospective Register of Systematic Reviews [PROSPERO] registration: CRD42022364349). The PubMed, Scopus, the Excerpta Medica dataBASE (EMBASE), and the Literatura Latino‐Americana e do Caribe em Ciências da Saúde (LILACS) databases were searched in September 2022. For comparative and non‐comparative studies, incidence estimates and odds ratios (ORs), respectively, for the main variables regarding safety of vascular closure devices were pooled by using random effects meta‐analyses. Quality assessment of the included comparative studies was conducted using the Risk Of Bias In Non‐randomised Studies of Interventions (ROBINS‐I) tool.ResultsOf the 863 articles obtained, data were retrieved from 44 studies, which included 42 902 patients. In non‐comparative studies, the pooled estimate rates for device failure, severe haemorrhage rate, conversion to open surgery, and mortality were similar for both clips and staplers. Regarding the meta‐analyses for comparative studies (three studies), there were no significant differences between the two groups for the severe haemorrhage rate (OR 0.57, 95% confidence interval [CI] 0.18–1.75; P = 0.33), conversion to open surgery (OR 0.35, 95% CI 0.08–1.54; P = 0.16), or death rate (OR 3.64, 95% CI 0.47–28.45; P = 0.22). Based on weak evidence, device failure was lower in the polymer clip group (OR 0.41, 95% CI 0.23–0.75; P = 0.00).ConclusionsThis study has confirmed that there is no evidence for the superiority of any vascular closure device in terms of safety in LDN. Standardised recommendations for vascular control in this context should be carefully designed and prospectively evaluated.

show abstract

Push toward pre-emptive kidney transplantation – for sure?

Cseprekal,

Jacquelinet,

Massy

2024

Clinical Kidney Journal

View full text Add to dashboard Cite

Preemptive kidney transplantation (PKT) has long been considered the optimal treatment for patients with end-stage chronic kidney disease (CKD) seeking the most favorable long-term outcomes. However, the significant growth in transplant procedures over recent decades has led to a notable increase in waitlisted patients and a disproportionate demand for donor organs. This situation necessitates a reevaluation of transplantation timing and the establishment of rational indications from both societal and clinical perspectives. An increasing number of retrospective analyses have challenged the universal benefit of PKT, suggesting that premature indications for living or deceased donor PKT may not always yield superior hard outcomes compared to non-PKT approaches. Conventional predictive models have shown limitations in accurately assessing risks for certain subpopulations, potentially leading to significant disparities among waitlisted patients. To address these challenges, we propose the following considerations. Prediction models should not only optimize the distribution of our limited donor resources but also illuminate foreseeable risks associated with a potentially ‘unsuccessful’ PKT. Therefore, our paper seeks to underscore the necessity for further discourse on the smoldering concept of when and for whom living or deceased donor PKT should be considered. Is it universally beneficial, or should the clinical paradigm be reevaluated? In the endeavor to attain superior post-PKT survival outcomes compared to non-PKT or conservative treatment, it seems critical to acknowledge that other treatments may provide more favorable results for certain individuals. This introduces the intricate task of effectively navigating the complexities associated with ‘too early’ or ‘unsuccessful’ PKT.

show abstract

Live donor kidney transplantation. Situation analysis and roadmap

Cited by 4 publications

References 11 publications

Complex management and descriptive cost analysis of kidney transplant candidates: a descriptive cross-sectional study

Complex management and descriptive cost analysis of kidney transplant candidates: a descriptive cross-sectional study

Vascular closure devices in living‐donor nephrectomy: a much‐needed systematic review and meta‐analysis focusing on safety

Push toward pre-emptive kidney transplantation – for sure?

Contact Info

Product

Resources

About