The Influence of Deceased Donor Age and Old-for-Old Allocation on Kidney Transplant Outcome

Moers, Cyril; Kornmann, Nirvana S. S.; Leuvenink, Henri G. D.; Ploeg, Rutger J.

doi:10.1097/tp.0b013e3181b0fa8b

Cited by 54 publications

(35 citation statements)

References 24 publications

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“…However, these organs show a higher risk for unfavorable outcome as they are more susceptible to ischemia reperfusion injury (IRI) (2, 3). In the need to improve organ viability and function, most notably machine perfusion has been proven to exert beneficial effects on organ preservation in a number of experimental and clinical trials (4–7).…”

Section: Introductionmentioning

confidence: 99%

Graft Pre-conditioning by Peri-Operative Perfusion of Kidney Allografts With Rabbit Anti-human T-lymphocyte Globulin Results in Improved Kidney Graft Function in the Early Post-transplantation Period—a Prospective, Randomized Placebo-Controlled Trial

et al. 2018

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Introduction: Although prone to a higher degree of ischemia reperfusion injury (IRI), the use of extended criteria donor (ECD) organs has become reality in transplantation. We therefore postulated that peri-operative perfusion of renal transplants with anti-human T-lymphocyte globulin (ATLG) ameliorates IRI and results in improved graft function.Methods: We performed a randomized, single-blinded, placebo-controlled trial involving 50 kidneys (KTx). Prior to implantation organs were perfused and incubated with ATLG (AP) (n = 24 kidney). Control organs (CP) were perfused with saline only (n = 26 kidney). Primary endpoint was defined as graft function reflected by serum creatinine at day 7 post transplantation (post-tx).Results: AP-KTx recipients illustrated significantly better graft function at day 7 post-tx as reflected by lower creatinine levels, whereas no treatment effect was observed after 12 months surveillance. During the early hospitalization phase, 16 of the 26 CP-KTx patients required dialysis during the first 7 days post-tx, whereas only 10 of the 24 AP-KTx patients underwent dialysis. No treatment-specific differences were detected for various lymphocytes subsets in the peripheral blood of patients. Additionally, mRNA analysis of 0-h biopsies post incubation with ATLG revealed no changes of intragraft inflammatory expression patterns between AP and CP organs.Conclusion: We here present the first clinical study on peri-operative organ perfusion with ATLG illustrating improved graft function in the early period post kidney transplantation.Clinical Trial Registration: www.ClinicalTrials.gov, NCT03377283

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Section: Introductionmentioning

confidence: 99%

Graft Pre-conditioning by Peri-Operative Perfusion of Kidney Allografts With Rabbit Anti-human T-lymphocyte Globulin Results in Improved Kidney Graft Function in the Early Post-transplantation Period—a Prospective, Randomized Placebo-Controlled Trial

et al. 2018

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“…The creation of standardized and validated processes for risk model development, using data from national registries, could help transplant teams worldwide and facilitate international comparisons in order to improve transplant outcomes, as previously suggested [130]. Additionally, very few models have exclusively assessed patient survival in advanced-age recipients or they have only focused on the effect of age on survival [32, 40, 41, 55, 63, 108, 112, 116, 118]. As a consequence, there is currently no consensus about the optimal survival prediction risk score for elderly KT.…”

Section: Prediction Of Mortality and Comorbidity In Waiting-list Patimentioning

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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“…In kidney transplantation, donor age is a limiting factor of long-term graft survival for organs from both deceased and living donors (1, 2). Likewise, donor age has been linked to delayed graft function (DGF) (1, 2) and higher rates of acute rejection (3, 4).…”

Section: Effects Of Donor Age On Clinical Transplant Outcomesmentioning

confidence: 99%

“…Likewise, donor age has been linked to delayed graft function (DGF) (1, 2) and higher rates of acute rejection (3, 4). At the same time, DGF has been associated with higher rates of acute rejection episodes (5).…”

Section: Effects Of Donor Age On Clinical Transplant Outcomesmentioning

confidence: 99%

Mechanisms and Consequences of Injury and Repair in Older Organ Transplants

et al. 2014

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Donor organ scarcity remains a significant clinical challenge in transplantation. Older organs, increasingly utilized to meet the growing demand for donor organs, have been linked to inferior transplant outcomes. Susceptibility to organ injury, reduced repair capacity, and increased immunogenicity are interrelated and impacted by physiological and pathological aging processes. Insights into the underlying mechanisms are needed to develop age-specific interventional strategies with regards to organ preservation, immunosuppression, and allocation. In this overview, we summarize current knowledge of injury and repair mechanisms and the effects of aging relevant to transplantation.

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The Influence of Deceased Donor Age and Old-for-Old Allocation on Kidney Transplant Outcome

Cited by 54 publications

References 24 publications

Graft Pre-conditioning by Peri-Operative Perfusion of Kidney Allografts With Rabbit Anti-human T-lymphocyte Globulin Results in Improved Kidney Graft Function in the Early Post-transplantation Period—a Prospective, Randomized Placebo-Controlled Trial

Graft Pre-conditioning by Peri-Operative Perfusion of Kidney Allografts With Rabbit Anti-human T-lymphocyte Globulin Results in Improved Kidney Graft Function in the Early Post-transplantation Period—a Prospective, Randomized Placebo-Controlled Trial

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

Mechanisms and Consequences of Injury and Repair in Older Organ Transplants

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