The Clinical Course of Kidney Transplant Recipients After 20 Years of Graft Function

McCaughan, Jennifer; Courtney, Aisling E.

doi:10.1111/ajt.13041

Cited by 31 publications

(43 citation statements)

References 25 publications

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“…In a study from Northern Ireland, of the 706 KTRs transplanted between 1968 and 1993, 117 (16%) were still alive with a functional graft 20 years post transplantation [20]. The authors concluded that in these long-term kidney graft survivals, the focus of management should be on the prevention of cancers and CVD, as the prevalence was very high in these patients.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of Kidney Transplant Recipients with a Functioning Graft for More than 25 Years

et al. 2018

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Background: Information regarding the clinical characteristics and outcomes of kidney transplant recipients (KTRs) with > 25 years of graft survival is limited. Methods: In this single-center observational study, we characterized KTRs transplanted between 1973 and 1992 with active follow-up as of July 31, 2017. Results: We identified 112 patients with > 25 years of allograft function. The mean posttransplantation follow-up was 29.8 ± 4.0 years. Glomerulonephritis was the most common cause of end-stage renal disease (ESRD) (52%). The majority received live donor transplants (66%), including 25 patients (22%) with human leukocyte antigen-matched kidneys. The incidence of biopsy-confirmed acute rejection was 21%, ranging from 0 to 26 years post transplantation. Donor-specific antibodies (DSA) were checked in 80% of patients at a mean of 28.4 ± 0.11 years post transplantation. Of these, only 15% were positive. The incidence of malignancy was 44%, with nonmelanoma skin cancers being most common. The incidence of infectious complications was 77%, mostly represented by urinary tract infections. At the time of last follow-up, 63% were on a calcineurin inhibitor (CNI)-free regimen, mean serum creatinine was 1.4 ± 0.6 mg/dL, and the prevalence of hypertension and dyslipidemia was 89 and 88%, respectively. Conclusion: The majority of patients with a long-term functioning graft had glomerulonephritis as cause of ESRD, had received a live donor kidney, were on a CNI-free regimen, and had a low incidence of DSA and opportunistic infections. These characteristics define a unique group of patients requiring specific posttransplantation monitoring and management.

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Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of Kidney Transplant Recipients with a Functioning Graft for More than 25 Years

et al. 2018

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“…Living donor kidney transplantation (LDKT) provides the greatest opportunity to maximize long-term patient and graft survival (1–4). Although multiple factors contribute to prolonged graft survival for LDKT recipients, human leukocyte antigen (HLA) matching remains a very impactful determinant of long-term outcome (5–8).…”

Section: Introductionmentioning

confidence: 99%

“…Living donor (LD) kidney transplantation provides the greatest opportunity to maximize long-term patient and graft survival. [1][2][3][4] Although multiple factors contribute to prolonged graft survival for LDKT recipients, HLA matching remains an important determinant of long-term outcome. [5][6][7][8] First-degree genetic relatives (ie, siblings, parents, offspring), therefore, represent a prevalent and accessible pool of wellmatched kidneys 1,9 that may optimize long-term allograft outcomes.…”

Section: Introductionmentioning

confidence: 99%

Inferior long-term allograft and patient outcomes among recipients of offspring living donor kidneys

Cohen

Owei

Sawinski

et al. 2018

American Journal of Transplantation

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While offspring-to-parent living donor kidney transplantations may represent an ideal donor-recipient combination to optimize long-term transplantation outcomes, the sex-specific long-term success of these transplantations remains unclear. We hypothesize that allograft and recipient survivals in offspring-to-parent living donor kidney transplantation differ between men and women due to donor-specific alloimmunization during pregnancy. We retrospectively analyzed long-term allograft and patient survival among men and women who received an offspring living donor kidney compared with those who received other haplotype-matched living donor kidneys. Based on multivariable Cox proportional hazards modeling of Organ Procurement and Transplantation Network data from 2001 to 2015, we found that both men and women who received offspring living donor kidneys had significantly increased mortality compared with recipients who received nonoffspring living donor kidneys. While male recipients of any living donor kidney had greater risk of mortality and allograft failure than female recipients, there was no significant difference in all-cause allograft failure or mortality in male versus female recipients of offspring living donor kidney transplantations. Our analysis demonstrated no significant interaction between recipient sex and donor offspring status. We conclude that nonoffspring living donors should be considered whenever feasible for both men and women with multiple donor options.

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“…Success rates in patient management and graft survival following kidney transplantation are greater now than ever before; however, graft and patient survival is compromised following the diarrheal infection. Although NVDI appears to be less deleterious on patient and graft outcomes than infection with Clostridioides difficile , it does appear to be associated with a reduction in graft survival.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Norovirus diarrheal infections and Clostridioides difficile infections in kidney transplant recipients: A single‐center retrospective study

Rolak¹,

Bartolomeo²,

Jorgenson

et al. 2019

Transplant Infectious Dis

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Recently, Norovirus has been recognized as an important cause of diarrheal infection in kidney transplant recipients (KTRs). We assessed the risk factors and outcomes of Norovirus diarrheal infections (NVDI) and Clostridioides difficile infection (CDI) on graft and patient survival following kidney transplant (KT). We examined KTRs transplanted at our center between 1994 and 2014, and compared those who suffered from NVDI and CDI with patients who did not develop either infection. Each patient with NVDI or CDI was matched with five controls based on time from transplant. Of the 4941 KTs performed during the study period, there were 2112 evaluable cases: 66 NVDI cases, 286 CDI cases, and 1760 controls. Median uncensored graft survival following infection was 497.5 days for the NVDI group, 440 days for the CDI group, and 1271 days for controls. Those with CDI had significantly inferior graft survival than controls (HR 2.41; CI 2.01, 2.90; P < 0.001), and those with NVDI had a 23% lower risk of graft survival than controls (HR 1.23; CI 1.0, 1.52; P = 0.054). Diarrheal infection after KT is associated with reduced long‐term graft survival.

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The Clinical Course of Kidney Transplant Recipients After 20 Years of Graft Function

Cited by 31 publications

References 25 publications

Characteristics and Outcomes of Kidney Transplant Recipients with a Functioning Graft for More than 25 Years

Characteristics and Outcomes of Kidney Transplant Recipients with a Functioning Graft for More than 25 Years

Inferior long-term allograft and patient outcomes among recipients of offspring living donor kidneys

Outcomes of Norovirus diarrheal infections and Clostridioides difficile infections in kidney transplant recipients: A single‐center retrospective study

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