Strategies for an Expanded Use of Kidneys From Elderly Donors

Pérez‐Sáez, María José; Montero, Núria; Redondo-Pachón, Dolores; Crespo, Marta; Pascual, Julio

doi:10.1097/tp.0000000000001635

Cited by 76 publications

(50 citation statements)

References 193 publications

(339 reference statements)

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“…Our study also shows that the use of a relatively low threshold (RS ≤ 4) appears to be safe for single kidney transplantation and identifies good organs from donors with several risk factors that would otherwise be rejected. Of importance, dual kidney transplantation in ECD donors has recently been reported not offer greater advantages , while our results demonstrate the good functioning of single kidney transplantation with marginal kidneys.…”

Section: Discussionsupporting

confidence: 46%

Histopathological evaluation of pretransplant donor biopsies in expanded criteria donors with high kidney donor profile index: a retrospective observational cohort study

et al. 2017

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There is no consensus on the allocation of renal transplants from expanded criteria donors (ECD). The Kidney Donor Profile Index (KDPI) is used without the need for pretransplant donor biopsies (PTDB). We explored whether PTDB based on Remuzzi Score (RS) allows identification of those marginal kidneys in the highest calculated KDPI risk group (>91%) that appropriate for single transplantation. A retrospective study was conducted of 485 consecutive kidneys procured from a single center and transplanted if the RS was ≤4. We compared 5-year kidney and patients survival between KDPI groups and between RS <4 or =4 in the highest KDPI group. The median KDPI (interquartile range) was 71 (66-76) for KDPI <80% (n = 77), 86 (81-90) for KDPI 81-90% (n = 82), and 97 (94-100) for KDPI >91% (n = 205). Patient survival at 5 years was 85.7%, 85.3%, and 76.09% (P = 0.058) and death-censored graft survival was 84.4%, 86.5%, 73.6% (P = 0.015), respectively for each KDPI group. In >91% calculated KDPI group, there were no differences in graft survival depending on the RS (<4 vs. =4) (P = 0.714). The implementation of PTDB based on RS used for allocation of organs with the highest KDPI range could support to the acceptance of suitable organs for single transplantation with good patient and graft survival rate.

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Section: Discussionsupporting

confidence: 46%

Histopathological evaluation of pretransplant donor biopsies in expanded criteria donors with high kidney donor profile index: a retrospective observational cohort study

et al. 2017

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“…Nonetheless, it is possible that the beneficial effect on survival of KT is not so robust in patients aged >70 years, diabetics and those with chronic obstructive pulmonary disease, as previously reported by Perez-Saez et al [68], suggesting that this benefit may not be extrapolatable to older patients. However, a later systematic review carried out by these same authors showed an overall better patient survival at the fifth year post-transplantation in elderly KT recipients compared with age-matched waitlisted patients [69]. …”

Section: Comparing Mortality Risk On Waiting-list Versus Post-transplmentioning

confidence: 99%

Mortality in Elderly Waiting-List Patients Versus Age-Matched Kidney Transplant Recipients: Where is the Risk?

Hernández

Alonso-Titos

Armas-Padrón³

et al. 2018

Kidney Blood Press Res

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The number of elderly patients on the waiting list (WL) for kidney transplantation (KT) has risen significantly in recent years. Because KT offers a better survival than dialysis therapy, even in the elderly, candidates for KT should be selected carefully, particularly in older waitlisted patients. Identification of risk factors for death in WL patients and prediction of both perioperative risk and long-term post-transplant mortality are crucial for the proper allocation of organs and the clinical management of these patients in order to decrease mortality, both while on the WL and after KT. In this review, we examine the clinical results in studies concerning: a) risk factors for mortality in WL patients and KT recipients; 2) the benefits and risks of performing KT in the elderly, comparing survival between patients on the WL and KT recipients; and 3) clinical tools that should be used to assess the perioperative risk of mortality and predict long-term post-transplant survival. The acknowledgment of these concerns could contribute to better management of high-risk patients and prophylactic interventions to prolong survival in this particular population, provided a higher mortality is assumed.

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“…Currently, only limited data are available to predict progression to chronic kidney disease in patients who receive a kidney transplant. The recent evolution in recipient demographics and expansion of the donor pool have introduced several important variables that may contribute to the lack of improvement in longterm allograft survival but may be better matched with predicted patient survival [4][5][6][7]. Although the changes in the kidney allocation scoring system have led to presumed improved equity in organ availability for disadvantaged recipients, the transplant community is in need of an objective measure to aid in determining which patients are at the highest risk for graft failure [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Renal Function Variability: An Independent Risk Factor for Graft Loss and Death following Kidney Transplantation

et al. 2018

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Background: Several studies have been performed to evaluate surrogate markers of long-term allograft function in renal transplant recipients. These include serum creatinine, estimated glomerular filtration rate (eGFR), slope of eGFR, and more recently eGFR variability. The aim of this study was to measure eGFR slope while assessing the variability of this slope and if high variability occurring at any time post-transplant was predictive of poorer long-term outcomes in a large cohort of kidney transplant recipients. Methods: Adult solitary kidney transplant recipients transplanted between July 1, 2005 and July 31, 2015 were included. The primary outcome was time to graft loss, defined as return to chronic dialysis, retransplant, or death. Secondary outcomes were death-censored graft loss and acute allograft rejection. Cox regression was utilized for primary and secondary outcomes. Multivariate logistic regression was used to determine baseline factors predictive of high eGFR variability. Results: A total of 1,543 patients were included in the analysis. The percentage of patients who experienced an eGFR coefficient of variation of <30% was 79.6% (1,229/1,543), while 20.4% (314/1,543) patients had high eGFR variability (≥30%). Patients with high eGFR variability tended to be younger, African-American and female. Those with higher eGFR variability, accounting for confounding and other eGFR measures (peak and slope), had significantly lower overall patient and graft survival. Conclusion: This study provides a novel analysis of the utility of eGFR variability in a large cohort. The clinical use of the slope of eGFR and eGFR variability may aid in predicting long-term graft outcomes and facilitate early patient discussions to change the trajectory of allograft function.

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Strategies for an Expanded Use of Kidneys From Elderly Donors

Cited by 76 publications

References 193 publications

Histopathological evaluation of pretransplant donor biopsies in expanded criteria donors with high kidney donor profile index: a retrospective observational cohort study

Histopathological evaluation of pretransplant donor biopsies in expanded criteria donors with high kidney donor profile index: a retrospective observational cohort study

Mortality in Elderly Waiting-List Patients Versus Age-Matched Kidney Transplant Recipients: Where is the Risk?

Renal Function Variability: An Independent Risk Factor for Graft Loss and Death following Kidney Transplantation

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