US deceased kidney transplantation: Estimated GFR, donor age and KDPI association with graft survival.
AUC, area under curve
Age
CI, Confidence Interval
CKD, chronic kidney disease
CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration Equation
CPRA, calculated panel-reactive antibody
DCD, donation after circulatory death
Donation
ESRD, end stage renal disease
Glomerular filtration rate (GFR)
HHS, Department of Health and Human Services of the US government
HRSA, Health Resources and Services Administration, Agency within HHS
KDIGO, Kidney Disease Improving Global Outcomes
KDPI, kidney donor profile index
KDRI, kidney donor risk index
OPTN, Organ Procurement and Transplantation Network
Outcomes
Transplantation
eGFR, estimated glomerular filtration rate
eGFR-1, one year after transplantation
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
22
02
2021
revised:
20
05
2021
accepted:
04
06
2021
entrez:
13
8
2021
pubmed:
14
8
2021
medline:
14
8
2021
Statut:
epublish
Résumé
Despite a significant shortage of kidneys for transplantation in the US, kidneys from older deceased donors are infrequently transplanted. This is primarily over concern of graft quality and transplant durability. The US national transplant database (2000-2018) was assessed for deceased donor kidney transplant patient and graft survival, graft durability and stratified by donor age (<65 years>), Kidney Donor Profile Index (KDPI) and estimated glomerual filtration rate (GFR) one year post-transplantation (eGFR-1) were calculated. Recipients of kidneys transplanted from deceased donors >65 years had a lower eGFR-1, (median 39 ml/min) than recipients of younger donor kidneys (median 54 ml/min). However, death-censored graft survival, stratified by eGFR-1, demonstrated similar survival, irrespective of donor age or KDPI. The durability of kidney survival decreases as the achieved eGFR-1 declines. KDPI has a poor association with eGFR-1 and lesser for graft durability. While recipients of kidneys > 65 years had a higher one year mortality than younger kidney recipients, recipients of kidneys > 65 years and an eGFR-1 <30 ml/min, had a lower survival than an untransplanted waitlist cohort ( The durability of kidney graft survival after transplantation was associated with the amount of kidney function gained through the transplant (eGFR-1) and the rate of graft loss (return to dialysis) was not significantly associated with donor age. 24.9% of recipients of older donor kidneys failed to achieve sufficient eGFR-1 providing a transplant survival benefit. While there is significant benefit from transplanting older kidneys, better decision-making tools are required to avoid transplanting kidneys that provide insufficient renal function. None.
Sections du résumé
BACKGROUND
BACKGROUND
Despite a significant shortage of kidneys for transplantation in the US, kidneys from older deceased donors are infrequently transplanted. This is primarily over concern of graft quality and transplant durability.
METHODS
METHODS
The US national transplant database (2000-2018) was assessed for deceased donor kidney transplant patient and graft survival, graft durability and stratified by donor age (<65 years>), Kidney Donor Profile Index (KDPI) and estimated glomerual filtration rate (GFR) one year post-transplantation (eGFR-1) were calculated.
FINDINGS
RESULTS
Recipients of kidneys transplanted from deceased donors >65 years had a lower eGFR-1, (median 39 ml/min) than recipients of younger donor kidneys (median 54 ml/min). However, death-censored graft survival, stratified by eGFR-1, demonstrated similar survival, irrespective of donor age or KDPI. The durability of kidney survival decreases as the achieved eGFR-1 declines. KDPI has a poor association with eGFR-1 and lesser for graft durability. While recipients of kidneys > 65 years had a higher one year mortality than younger kidney recipients, recipients of kidneys > 65 years and an eGFR-1 <30 ml/min, had a lower survival than an untransplanted waitlist cohort (
INTERPRETATION
CONCLUSIONS
The durability of kidney graft survival after transplantation was associated with the amount of kidney function gained through the transplant (eGFR-1) and the rate of graft loss (return to dialysis) was not significantly associated with donor age. 24.9% of recipients of older donor kidneys failed to achieve sufficient eGFR-1 providing a transplant survival benefit. While there is significant benefit from transplanting older kidneys, better decision-making tools are required to avoid transplanting kidneys that provide insufficient renal function.
FUNDING
BACKGROUND
None.
Identifiants
pubmed: 34386752
doi: 10.1016/j.eclinm.2021.100980
pii: S2589-5370(21)00260-1
pmc: PMC8343266
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100980Informations de copyright
© 2021 The Author(s).
Déclaration de conflit d'intérêts
TP is a Board member of an Organ Procurement Organization (Lifesource). All the other authors declare no conflicts of interest.
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