Characteristics and Performance of Unilateral Kidney Transplants from Deceased Donors
Copyright © 2018 by the American Society of Nephrology..
BACKGROUND AND OBJECTIVES: The fraction of kidneys procured for transplant that are discarded is rising in the United States. Identifying donors from whom only one kidney was discarded allows us to control for donor traits and better assess reasons for organ discard.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective cohort study using United Network for Organ Sharing Standard Transplant Analysis and Research file data to identify deceased donors from whom two kidneys were procured and at least one was transplanted. Unilateral pairs were defined as kidney pairs from a single donor from whom one kidney was discarded ("unilateral discard") but the other was transplanted ("unilateral transplant"). Organ quality was estimated using the Kidney Donor Risk Index and Kidney Donor Profile Index (KDPI). We compared all-cause graft failure rates for unilateral transplants to those for bilateral transplant Kaplan-Meier methods, and life table methodology was used to evaluate 1-, 2-, 3-, and 5-year survival rates of transplants from bilateral and unilateral donors.
RESULTS: Compared with bilateral donors (i.e., both kidneys transplanted) (n=80,584), unilateral donors (i.e., only one kidney transplanted) (n=7625) had higher mean terminal creatinine (1.3±2.1 mg/dl versus 1.1±0.9 mg/dl) and KDPI (67%±25% versus 42%±27%), were older, and were more likely to have hypertension, diabetes, hepatitis C, terminal stroke, or meet Centers for Disease Control and Prevention high-risk donor criteria. Unilateral discards were primarily attributed to factors expected to be similar in both kidneys from a donor: biopsy findings (22%), no interested recipient (13%), and donor history (7%). Anatomic abnormalities (14%), organ damage (11%), and extended ischemia (6%) accounted for about 30% of discards, but were the commonest reasons among low KDPI kidneys. Among kidneys with KDPI≥60%, there was an incremental difference in allograft survival over time (for unilateral versus bilateral transplants, 1-year survival: 83% versus 87%; 3-year survival: 69% versus 73%; 5-year survival: 51% versus 58%).
CONCLUSIONS: A large number of discarded kidneys were procured from donors whose contralateral kidneys were transplanted with good post-transplant outcomes.
| Errataetall: |
CommentIn: Clin J Am Soc Nephrol. 2018 Jan 6;13(1):13-15. - PMID 29217538 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Clinical journal of the American Society of Nephrology : CJASN - 13(2018), 1 vom: 06. Jan., Seite 118-127 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Husain, Syed Ali [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 16.07.2019 Date Revised 13.08.2023 published: Print-Electronic CommentIn: Clin J Am Soc Nephrol. 2018 Jan 6;13(1):13-15. - PMID 29217538 Citation Status MEDLINE |
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| doi: |
10.2215/CJN.06550617 |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Characteristics and Performance of Unilateral Kidney Transplants from Deceased Donors |
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| 500 | |a Date Revised 13.08.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Clin J Am Soc Nephrol. 2018 Jan 6;13(1):13-15. - PMID 29217538 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2018 by the American Society of Nephrology. | ||
| 520 | |a BACKGROUND AND OBJECTIVES: The fraction of kidneys procured for transplant that are discarded is rising in the United States. Identifying donors from whom only one kidney was discarded allows us to control for donor traits and better assess reasons for organ discard | ||
| 520 | |a DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective cohort study using United Network for Organ Sharing Standard Transplant Analysis and Research file data to identify deceased donors from whom two kidneys were procured and at least one was transplanted. Unilateral pairs were defined as kidney pairs from a single donor from whom one kidney was discarded ("unilateral discard") but the other was transplanted ("unilateral transplant"). Organ quality was estimated using the Kidney Donor Risk Index and Kidney Donor Profile Index (KDPI). We compared all-cause graft failure rates for unilateral transplants to those for bilateral transplant Kaplan-Meier methods, and life table methodology was used to evaluate 1-, 2-, 3-, and 5-year survival rates of transplants from bilateral and unilateral donors | ||
| 520 | |a RESULTS: Compared with bilateral donors (i.e., both kidneys transplanted) (n=80,584), unilateral donors (i.e., only one kidney transplanted) (n=7625) had higher mean terminal creatinine (1.3±2.1 mg/dl versus 1.1±0.9 mg/dl) and KDPI (67%±25% versus 42%±27%), were older, and were more likely to have hypertension, diabetes, hepatitis C, terminal stroke, or meet Centers for Disease Control and Prevention high-risk donor criteria. Unilateral discards were primarily attributed to factors expected to be similar in both kidneys from a donor: biopsy findings (22%), no interested recipient (13%), and donor history (7%). Anatomic abnormalities (14%), organ damage (11%), and extended ischemia (6%) accounted for about 30% of discards, but were the commonest reasons among low KDPI kidneys. Among kidneys with KDPI≥60%, there was an incremental difference in allograft survival over time (for unilateral versus bilateral transplants, 1-year survival: 83% versus 87%; 3-year survival: 69% versus 73%; 5-year survival: 51% versus 58%) | ||
| 520 | |a CONCLUSIONS: A large number of discarded kidneys were procured from donors whose contralateral kidneys were transplanted with good post-transplant outcomes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Research Support, U.S. Gov't, P.H.S. | |
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| 650 | 4 | |a Centers for Disease Control and Prevention (U.S.) | |
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| 650 | 4 | |a Life Tables | |
| 650 | 4 | |a Retrospective Studies | |
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| 650 | 4 | |a creatinine | |
| 650 | 4 | |a diabetes mellitus | |
| 650 | 4 | |a hypertension | |
| 650 | 4 | |a kidney | |
| 650 | 4 | |a kidney transplantation | |
| 650 | 4 | |a transplant outcomes | |
| 700 | 1 | |a Chiles, Mariana C |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Samnang |e verfasserin |4 aut | |
| 700 | 1 | |a Pastan, Stephen O |e verfasserin |4 aut | |
| 700 | 1 | |a Patzer, Rachel E |e verfasserin |4 aut | |
| 700 | 1 | |a Tanriover, Bekir |e verfasserin |4 aut | |
| 700 | 1 | |a Ratner, Lloyd E |e verfasserin |4 aut | |
| 700 | 1 | |a Mohan, Sumit |e verfasserin |4 aut | |
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