Prognostic factors for kidney allograft survival in the Eurotransplant Senior Program

Bahde, Ralf; Vowinkel, Thorsten; Unser, Julia; Anthoni, Christoph; Hölzen, Jens Peter; Suwelack, Barbara; Senninger, N.; Wolters, Heiner

doi:10.12659/aot.890125

Cited by 28 publications

(23 citation statements)

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“…In these studies, patient and graft survival were comparable to our own results. Primary non-function seems to be high in our cohort (10.8%) but has also been observed in other ESP cohorts with similar rates ranging from 7.3% to 10.1% [ 11 – 14 ].…”

Section: Discussionsupporting

confidence: 87%

“…On the other hand, the risk of acute rejection has to be considered. In our patients, BPAR of 13.5% was quite low compared to other ESP cohorts, which had rates of BPAR ranging up to 37% [ 11 – 14 ]. Still, in our ESP patients, it was a relevant factor accounting for graft loss in 10.8% of the patients in the first year after transplantation.…”

Section: Discussioncontrasting

confidence: 64%

“…In 2008, Frei et al published the outcomes of more than 1400 patients transplanted in the ESP [ 4 ] representing the largest published cohort so far. More recent data regarding the outcome of patients in the ESP has been limited to few single center experiences [ 11 – 14 ]. In these studies, patient and graft survival were comparable to our own results.…”

Section: Discussionmentioning

confidence: 99%

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Association of Kidney Donor Risk Index with the Outcome after Kidney Transplantation in the Eurotransplant Senior Program

et al. 2018

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BackgroundWe evaluated the Kidney Donor Risk Index (KDRI) scoring system for kidney transplantation in the Eurotransplant Senior Program (ESP) that allocates kidneys from older donors to older recipients (≥65 years).Material/MethodsWe retrospectively analyzed data of 37 kidney transplant recipients and 36 kidney donors who participated in kidney transplantation program according to the ESP at our center from January 2004 until December 2013.ResultsMean recipient and donor age was 67.9±2.6 and 70.5±4.0 years respectively. The mean KDRI score was 1.7±0.27. Uncensored graft survival after 1 year and 5 years was 64.2% and 53.7% respectively. Subgroup analysis showed that in kidney transplantation with KDRI >1.83, graft survival was significantly reduced compared to lower KDRI subgroups. KDRI was significantly correlated with serum creatinine level at discharge (r=0.4).ConclusionsESP kidneys represent a group of high-risk grafts with high KDRI scores. Higher KDRI scores in ESP kidneys was associated with reduced postoperative short-term and long-term graft outcomes. KDRI might be useful in decision-making for selecting donors for ESP kidney transplantation.

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Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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Association of Kidney Donor Risk Index with the Outcome after Kidney Transplantation in the Eurotransplant Senior Program

et al. 2018

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“…We set the timing of treatment at three hours in order to keep the CIT as short as possible, due to its relation to organ dysfunction and survival [ 47 , 48 ]. Additionally, in our preliminary experiments, longer treatment times were not associated with better features of kidneys in terms of metabolic activity and tissue damage (data not reported).…”

Section: Discussionmentioning

confidence: 99%

Strategies to Restore Adenosine Triphosphate (ATP) Level After More than 20 Hours of Cold Ischemia Time in Human Marginal Kidney Grafts

et al. 2018

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BackgroundThe persisting organ shortage in the field of transplantation recommends the use of marginal kidneys which poorly tolerate ischemic damage. Adenosine triphosphate (ATP) depletion during cold ischemia time (CIT) is considered crucial for graft function. We tested different strategies of kidney perfusion before transplantation in the attempt to improve the technique.Material/MethodsTwenty human discarded kidneys from donors after brain death and with at least 20 hours of CIT were randomized to the following experimental groups (treatment time three-hours at 4°C): a) static cold storage (CS); b) static cold hyperbaric oxygenation (Hyp); c) hypothermic perfusion (PE); d) hypothermic perfusion in hyperbaric oxygenation (PE-Hyp); and e) hypothermic oxygenated perfusion (PE-O2).ResultsHistological results showed that perfusion with or without oxygen did not produce any endothelial damage. A depletion of ATP content following the preservation procedure was observed in CS, PE, and Hyp, while PE-Hyp and PE-O2 were associated with a net increase of ATP content with respect to baseline level. In addition, PE-Hyp was associated with a significant downregulation of endothelial isoform of nitric oxide synthase (eNOS) gene expression and of hypoxia inducible factor-1α (HIF-1α).ConclusionsHyperbaric or normobaric oxygenation with perfusion improves organ metabolic preservation compared to other methods. This approach may prevent the onset of delayed graft function, but clinical trials are needed to confirm this.

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“…However, the development of hematomas or bleeding episodes after ABOi RTx is rarely reported by centers using PPh or double filtration plasmapheresis and prevalence seems to be low with <5% [ 8 , 28 , 30 ]. Several studies showed that the overall surgical complication rate was higher in ABOi RTx patients than in ABOc RTx patients [ 27 , 31 ], with hematomas being the most frequently observed complication. In our study, surgical complications were not correlated with the use of a specific IA column which is in accordance to the data from Morath at al.…”

Section: Discussionmentioning

confidence: 99%

Antigen-Specific versus Non-Antigen-Specific Immunoadsorption in ABO-Incompatible Renal Transplantation

et al. 2015

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IntroductionABO-incompatible (ABOi) renal transplantation (RTx) from living donors is an established procedure to expand the donor pool for patients with end stage renal disease. Immunoadsorption (IA) is a standard procedure for the removal of preformed antibodies against the allograft. In this study, antigen-specific and non-antigen-specific IA in ABOi RTx were compared.Patients and Methods10 patients underwent antigen-specific IA (Glycosorb group) and 13 patients non-antigen-specific IA (Immunosorba group). The effects of both procedures regarding antibody reduction, number of treatments, complications, costs, as well as the allograft function and patient survival were compared between both groups.ResultsAlthough the IgG levels were reduced equally by both procedures (p=0.82), the reduction of the IgM level was more effective in the Glycosorb group (p=0.0172). Patients in both groups required a median number of 6 IA before ABOi RTx. Allograft function at one year after AB0i RTx was similar in both groups (estimated glomerular filtration rate: 66 vs. 64 ml/min/1.73m² respectively), with a death-censored graft survival of 90.0% and 92.3% respectively. Complication rates did not differ between procedures. Due to the reuse of non-antigen-specific Immunosorba columns, costs were considerably lower in this group; however, the use of the Immunosorba-based IA was less time-efficient.ConclusionConsidering upcoming alternatives as simultaneous performance of dialysis and IA or a possible reuse of Glycosorb columns, this might become less relevant in the future.

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Prognostic factors for kidney allograft survival in the Eurotransplant Senior Program

Abstract: Risk reduction (e.g., aiming at CIT <15 h) and close surveillance of patients at risk appear to be crucial for allograft survival in the ESP.

Cited by 28 publications

References 0 publications

Association of Kidney Donor Risk Index with the Outcome after Kidney Transplantation in the Eurotransplant Senior Program

Association of Kidney Donor Risk Index with the Outcome after Kidney Transplantation in the Eurotransplant Senior Program

Strategies to Restore Adenosine Triphosphate (ATP) Level After More than 20 Hours of Cold Ischemia Time in Human Marginal Kidney Grafts

Antigen-Specific versus Non-Antigen-Specific Immunoadsorption in ABO-Incompatible Renal Transplantation

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