Multicenter Analysis of Kidney Preservation

Opelz, Gerhard; Döhler, Bernd

doi:10.1097/01.tp.0000251781.36117.27

Cited by 191 publications

(182 citation statements)

References 23 publications

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“…We haven't assessed the reason of donor death. Similar to our findings, data from the Collaborative Transplant Study have shown that CIT, when less than 18 hours, has no significant affect on graft survival (17).…”

Section: Discussionsupporting

confidence: 80%

“…The overall incidence of arterial thrombosis ranges between 0.4-3.0% and venous thrombosis between 0.4-3.4% in DDKTx patients (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Deceased donor is a significant risk factor for developing renal allograft thrombosis along with donor age <6 or >60 years, recipient age <5-6 or >50 years, hemodynamic instability, peritoneal dialysis, recipient vessel atherosclerosis, diabetic nephropathy, a history of thrombosis, and DGF (24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

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Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey

Kumru¹,

Çelebi²,

Aktürk³

et al. 2016

Turk Neph Dial Transpl

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OBJECTIVE:Renal transplantation is the treatment of choice in end-stage renal diseases. Long-term allograft function has remained steady in deceased donor kidney transplantation (DDKTx) during recent decades. In this study, we evaluated DDKTx outcomes at our hospital. MATERIAL and METHODS:72 cadaveric transplant patients who were grafted between January 2002 and October 2013 at our center were analysed retrospectively. Recipients and donors' demographic properties, immunologic and nonimmunologic characteristics, allograft function and emerging complications were examined. Factors associated with graft and patient loss were investigated. RESULTS:Mean follow-up period was 60±38 months. Mean recipient age was 42±11 years, of which 51.4% was male. Dialysis vintage was 83±59 months, while mean cold ischemia time was 12±3 hours. One and five year graft and patient survival rates were 94.4%, 92.3% and 97.2%, 89.9% respectively. High serum creatinine value at discharge (p=0.003) and early surgical complications (p=0.041) were independent risk factors associated with poor graft survival. Having a recipient age ≥46 years (p=0.037) and cardiovascular disease (p=0.017) caused patient loss. Cardiovascular disease was independently associated with patient loss (HR=6.45[1.08-38.70], p=0.041). CONCLUSION:In this study, it was demonstrated that creatinine value at discharge and early surgical complications were associated with allograft loss, while cardiovascular disease was associated with patient loss in DDKTx. BULGULAR: Ortalama takip süresi 60±38 aydır. Alıcıların ortalama yaşı 42±11 yıl, %51.4'ü erkektir. Nakil öncesi ortalama diyaliz süresi 83±59 aydır. Ortalama soğuk iskemi zamanı 12±3 saattir. Bir ve beş yıllık graft sağkalımı sırasıyla %94.4, %92.3; hasta sağkalımı %97.2, %89.9'dur. Hastaneden çıkış kreatinini yüksekliği (p=0.003) ve erken cerrahi komplikasyonların gelişimi (p=0.041) graft sağkalımını olumsuz etkileyen bağımsız risk faktörleridir. Alıcı yaşı≥46 olması (p=0.037) ve kardiyovasküler hastalık gelişimi (p=0.017) hasta kaybını artırmaktadır. Kardiyovasküler hastalık gelişimi hasta kaybı için bağımsız risk faktörüdür (HR=6,], p=0.041).SONUÇ: Çalışmada, kadaverik böbrek nakillerinde hastaneden çıkış kreatinini yüksekliği ve erken cerrahi komplikasyonların gelişiminin allograft kaybını, kardiyovasküler hastalık gelişminin hasta kaybını artırdığı gösterilmiştir.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey

Kumru¹,

Çelebi²,

Aktürk³

et al. 2016

Turk Neph Dial Transpl

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“…CIT is one of the controllable factors affecting graft function. In a report of kidney preservation involving 91 674 transplants in 195 centres spread over three continents, Opelz and Dohler [86] showed that graft survival in deceased donor transplants remained stable for up to 18 h of cold ischaemia and worsened further with time, particularly after 36 h. However, there is little evidence on the benefits of reducing cold ischaemic injury within a 24 h period in DCD kidney transplantation. Hosgood et al [87] demonstrated the progressive effects of cold ischaemic injury in DCD porcine kidneys over a 24 h hypothermic storage period.…”

Section: Citmentioning

confidence: 99%

Kidney donation after cardiac death

Akoh¹

2012

WJN

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There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death (DCD) and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to controlled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function (DGF) and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that significantly influences the outcome of allografts, for example, limiting it to < 12 h markedly reduces DGF. DCD kidneys from donors < 50 function like standard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled donation, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kidneys from DCD include: implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.

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“…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]. Interestingly Kayler et al [56] demonstrated in ECD kidney transplants a higher incidence of DGF in those with longer cold ischemia time, but the overall graft loss rates were not significantly different between recipients with longer or shorter cold ischemia time.…”

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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Multicenter Analysis of Kidney Preservation

Cited by 191 publications

References 23 publications

Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey

Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey

Kidney donation after cardiac death

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

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Multicenter Analysis of Kidney Preservation

Cited by 191 publications

References 23 publications

Factors Affecting Allograft and Patient Survival in Deceased Donor ￼Kidney Transplantation: A Single Center Experience in Turkey

Factors Affecting Allograft and Patient Survival in Deceased Donor ￼Kidney Transplantation: A Single Center Experience in Turkey

Kidney donation after cardiac death

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

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Product

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Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey

Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey