Long term outcomes following kidney transplantation in children who weighed less than 15 kg – report from the UK Transplant Registry (original) (raw)
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Outcomes and Utilization of Kidneys from Deceased Donors with Acute Kidney Injury
American Journal of Transplantation, 2009
Utilization and long-term outcomes of kidneys from donors with elevated terminal serum creatinine (sCr) levels have not been reported. Using data from the Scientific Registry of Transplant Recipients from 1995 to 2007, recipient outcomes of kidneys from adult donors were evaluated stratified by standard criteria (SCD; n = 82 262) and expanded criteria (ECD; n = 16 978) donor type and by sCr ≤1.5, 1.6–2.0 and >2.0 mg/dL. Discard rates for SCDs were ascertained. The relative risk of graft loss was similar for recipients of SCD kidneys with sCr of 1.6–2.0 and >2.0 mg/dL, compared to ≤1.5 mg/dL. For ECD recipients, the relative risk of graft failure significantly increased with increasing sCr. Of potential SCDs, the adjusted risk of discard was higher with sCr >2.0 mg/dL (adjusted odds ratio [AOR] 7.04, 95% confidence interval [CI] 6.5–7.6) and 1.6–2.0 mg/dL (AOR 2.7; CI 2.5–2.9) relative to sCr ≤1.5 mg/dL. Among potential SCDs, elevated terminal creatinine is a strong independent risk factor for kidney discard; yet, when kidney transplantation is performed elevated donor terminal creatinine is not a risk factor for graft loss. Further research is needed to identify safe practices for the optimal utilization of SCD kidneys from donors with acute kidney injury.
Outcomes of Kidneys Utilized from Deceased Donors with Severe Acute Kidney Injury
QJM : monthly journal of the Association of Physicians, 2015
Background: Significant numbers of kidneys are discarded due to raised terminal creatinine of the donor. Aim: To determine long-term outcomes of kidneys utilized from donors with severe acute kidney injury (AKI). Methods: In this retrospective study, we included all patients who received kidneys from deceased donors between years 2000-2012. AKI was defined according to the acute kidney injury network (AKIN) classification. The primary outcomes were patient and graft survival and secondary outcomes were renal function at different time points, delayed graft function, acute rejection and length of hospital stay. Results: 284 recipients received kidneys from 261 deceased donors. 114 patients (40%) received kidneys from the donors with AKI. 42 patients received kidneys from the donors with severe AKI (AKIN-3 category). Mean age of the donor and recipient was 36 years and 37 years respectively. Main cause of death in donors was road traffic accident (34%) followed by cerebrovascular acci...
PLOS ONE, 2019
Background Given the gap between patients in need of a renal transplantation (RTx) and organs available, transplantation centers increasingly accept organs of suboptimal quality, e.g. from donors with acute kidney injury (AKI). Methods To determine the outcome of kidney transplants from deceased donors with AKI (defined as � AKIN stage 1), all 107 patients who received a RTx from donors with AKI between August 2004 and July 2014 at our center were compared to their respective consecutively transplanted patients receiving kidneys from donors without AKI. 5-year patient and graft survival, frequencies of delayed graft function (DGF), acute rejections and glomerular filtration rate (eGFR, CKD-EPI) were assessed. Results Patient survival was similar in both groups, whereas death-censored and overall graft survival were decreased in AKI kidney recipients. AKI kidney recipients showed higher frequencies of DGF and had a reduced eGFR at 7 days, three months and one and three years after RTx. However, mortality was noticeably lower compared to waiting list candidates. Rejection-free survival was similar between groups. Conclusions In our cohort, both short-term and long-term renal function was inferior in recipients of AKI kidneys, while patient survival was similar. Our data indicates that recipients of donor AKI
Successful use of kidneys from deceased donors with acute renal failure
Progress in Transplantation, 2007
T he gap between the number of kidneys needed for transplantation and their availability is everwidening. United Network for Organ Sharing (UNOS) data reveal that the current number of patients with end-stage renal disease waiting for a kidney transplant is 74 066, and 18 878 of those patients have been on the waiting list for 3 years or more. 1 During 2005, 4156 patients waiting for a kidney transplant died. 1 Similar figures are reported from virtually all European countries. 2 The number of patients waiting for a kidney transplant is estimated to be increasing 7.8% per year. 3 To address this major deficit, more and more transplant centers have been using "marginal" kidneys. 4,5 These include kidneys with long cold ischemia times (CITs), 6,7 kidneys from older donors, 8,9 kidneys from hypertensive and diabetic donors, 10 and kidneys from non-heart-beating donors. 11 At the Saudi Center for Organ Transplantation, we have noted that about a quarter of potential donor kidneys were rejected because of high serum levels of creatinine at the time of consent. As a result, starting at the beginning of 2003, kidneys from donors with acute renal failure (defined as a plasma level of creatinine >1.7 mg/dL [to convert to micromoles per liter, multiply by 88.4]) at organ recovery but with normal serum levels of creatinine (<1.1 mg/dL) at admission to the intensive care unit (ICU) were considered for donation, provided that no other contraindications to using the donor organs were apparent. We describe the outcomes in the recipients of such kidneys and compare those outcomes with the outcomes in recipients of kidneys with normal creatinine levels for the 3-year period from 2003 to 2005. The kidneys studied were refused by many of the kidney transplant centers in the Kingdom of Saudi Arabia before being accepted by 1 of the 2 centers participating in this study. Patients and Methods In this retrospective case-controlled study, the study group included deceased donors with a serum creatinine concentration of more than 1.7 mg/dL at retrieval (but with normal serum level of creatinine on admission to the ICU). The study group was compared with a control group of donors with normal serum levels of Successful use of kidneys from deceased donors with acute renal failure Background-Kidneys from deceased donors with acute renal failure are not widely used. Objective-To compare outcomes for recipients of kidneys from donors with acute renal failure at organ recovery with outcomes for recipients of kidneys from donors with normal serum levels of creatinine. Methods-Records of deceased donors and recipients of their organs at the Saudi Center for Organ Transplantation from 2003 to 2005 were reviewed. A total of 33 donors (donating 65 kidneys to 65 recipients) with elevated serum levels of creatinine (>1.7 mg/dL) and 94 donors (donating 188 kidneys to 188 recipients) with normal (<1.1 mg/dL) serum levels of creatinine at organ recovery and their respective recipients were compared. Both groups had normal creatinine levels at admission. Results-Recipients in both groups had similar renal function at discharge and follow-up. Delayed graft function occurred more often (P = .009) in the recipients of kidneys from donors with acute renal failure (47.7%) than in recipients of kidneys from donors with normal creatinine levels (29.8%). Elevation of serum level of creatinine at organ recovery did not correlate significantly with kidney function at discharge or last follow-up or with graft survival. Conclusions-Survival of patients or grafts at 1, 2, and 3 years did not differ significantly between the recipients in the 2 groups. Only the frequency of delayed graft function differed between the 2 groups.
Deceased-donor acute kidney injury is not associated with kidney allograft failure
Kidney International, 2018
Deceased-donor acute kidney injury (AKI) is associated with organ discard and delayed graft function, but data on longer-term allograft survival are limited. We performed a multicenter study to determine associations between donor AKI (from none to severe based on AKI Network stages) and all-cause graft failure, adjusting for donor, transplant, and recipient factors. We examined whether any of the following factors modified the relationship between donor AKI and graft survival: kidney donor profile index, cold ischemia time, donation after cardiac death, expandedcriteria donation, kidney machine perfusion, donor-recipient gender combinations, or delayed graft function. We also evaluated the association between donor AKI and a 3-year composite outcome of all-cause graft failure or estimated glomerular filtration rate ≤ 20 mL/min/1.73m2 in a subcohort of 30% of recipients. Among 2,430 kidneys transplanted from 1,298 deceased donors, 585 (24%) were from donors with AKI. Over a median follow-up of 3.7 years, there were no significant differences in graft survival by donor AKI stage. We found no evidence that prespecified variables modified the effect of donor AKI on graft survival. In the subcohort, donor AKI was not associated with the 3-year composite outcome. Donor AKI was not associated with graft failure in this well-phenotyped cohort. Given the organ shortage, the transplant community should consider measures to increase utilization of kidneys from deceased donors with AKI.
Kidney transplantation from deceased donors with high terminal serum creatinine
2013
The increasing number of possible recipients for kidney transplantation and relatively unchanged number of organ donors has led to consideration of alternative strategies and expansion of deceased donor criteria in order to expand donor pool. Previously, kidneys from expanded criteria donors (ECD) were strongly underestimated because of the conventional opinion suggesting these kidneys to have a higher rate of preservation injury, delayed graft function, rejection and nonfunction. Reducing the difference between graft outcome in patients transplanted from ECD and standard criteria donor (SCD) is one of the goals of many respectable kidney transplantation centers. This assignment includes major concern about reduction of cold ischemia time, recipient selection, novel and adapted immunosuppressive regimens, increased nephron mass by dual kidney transplantation, and using histologic criteria for marginal donor graft selection. There are not many reports on the outcome of kidneys transp...
Transplant International
While deceased donor renal transplants (DDRT) from donors with either acute kidney injury (AKI) or long cold ischemia time (CIT) are associated with increased risk of delayed graft function (DGF), recipients of these kidneys have good patient and allograft survival. There are limited data on whether kidneys with both AKI and long CIT have outcomes similar to kidneys with only one of these insults. Using data from the Scientific Registry of Transplant Recipients, we analyzed transplant outcomes in patients (2005-2015) receiving kidneys with AKI (terminal creatinine ≥2.0 mg/dl) and CIT 24-30 h (n = 1289), 30-36 h (n = 734), and >36 h (n = 614), using kidneys with AKI and CIT <24 h (n = 5434) as a reference. DGF was more common with increasing CIT up to 36 h, then decreased slightly (41.2% vs. 46.8% vs. 52.5% vs. 50.2%, P < 0.001). Death-censored graft survival (DCGS) at 3 years was better with CIT <24 h compared with other groups (92.5% vs. 90.8% vs. 92% vs. 89.2%, P = 0.018). On multivariable analysis, donor creatinine was predictive of DCGS, whereas only CIT >36 h was predictive of DCGS (aHR 1.27, P = 0.03). Recipients transplanted with kidneys with both AKI and long CIT have excellent intermediate-term outcomes.
European Surgical Research, 2019
Background: Short-term kidney graft dysfunction is correlated with complications and it is associated with a decreased long-term survival; therefore, a scoring system to predict shortterm renal transplant outcomes is warranted. Aim: The aim of this study is to quantify the impression of the organ procurement surgeon in correlation with the following kidney transplant outcomes: immediate graft function (IGF), delayed graft function (DGF), and primary nonfunction (PNF). Results are compared to factors associated with the 1-year outcome. Methods: A regional prospective pilot study was performed using deceased-donor organ assessment forms to be filled out by procurement surgeons after procurement. Data were gathered on kidney temperature, perfusion, anatomy, atherosclerosis, and overall quality. Results: Included were 90 donors who donated 178 kidneys, 166 of which were transplanted. Variables that were significantly more prevalent in the DGF-or-PNF group (n = 65) are: large kidney size (length, p = 0.008; width, p = 0.036), poor perfusion quality (p = 0.037), lower diuresis (p = 0.039), fewer hypotensive episodes (p = 0.003), and donation-after-circulatory-death donors (p = 0.017). Multivariable analysis showed that perfusion quality and kidney width significantly predicted the short-term outcome. However multivariable analysis of long-term outcomes showed that the first measured donor creatinine, kidney donor risk index, IGF vs. DGF+PNG, and kidney length predicted outcomes. Conclusions: Results show that short-term
PLOS ONE, 2021
Background The need for kidney transplantation drives efforts to expand organ donation. The decision to accept organs from donors with acute kidney injury (AKI) can result in a clinical dilemma in the context of conflicting reports from published literature. Material and methods This observational study included all deceased donor kidney transplants performed in Australia and New Zealand between 1997 and 2017. The association of donor-AKI, defined according to KDIGO criteria, with all-cause graft failure was evaluated by multivariable Cox regression. Secondary outcomes included death-censored graft failure, death, delayed graft function (DGF) and acute rejection. Results The study included 10,101 recipients of kidneys from 5,774 deceased donors, of whom 1182 (12%) recipients received kidneys from 662 (11%) donors with AKI. There were 3,259 (32%) all-cause graft failures, which included 1,509 deaths with functioning graft. After adjustment for donor, recipient and transplant characte...