https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajt.12871

Organ Procurement From Executed Prisoners in China

With an increased incidence of living-donor kidney transplants, in response to increasing unmet needs for renal transplant, a clear understanding of determinants of posttransplant outcomes is essential. The importance of delayed graft function in deceased-donor kidney transplant is now part of conventional medical wisdom, due to the large amount of evidence focused on this aspect. However, the same is not true for living-donor kidney transplant, partly due to lack of evidence on this crucial clinical question and partly due to lack of awareness about this issue. The current review aims to highlight the importance of delayed graft function as a crucial determinant of outcomes in living-donor kidney transplant. An exhaustive search of online medical databases was performed with appropriate search criteria to collect evidence about delayed graft function after living-donor kidney transplant, with a special focus on studies from the Middle East. Data on incidence, impact, risk factors, and possible prevention modalities of delayed graft function in patients undergoing living-donor kidney transplant are presented. A key finding of this review is that contemporary incidence rates reported from the Middle East are comparatively higher than those reported from outside the region. Although in absolute terms the incidence is lower than deceased donor kidney transplant, the effects of delayed graft function on graft rejection and graft and patient survival are sufficiently large to warrant the formulation of specific treatment protocols. Key to formulating prevention and treatment strategies is identifying discrete risk factors for delayed graft function. Although this evidence is scant, an overview has been provided. Further studies examining different aspects of delayed graft function incidence after living-donor kidney transplant are urgently needed to address a so far little known clinical question.

Delayed Graft Function in Living-Donor Kidney Transplant: A Middle Eastern Perspective.

Objectives: To evaluate whether the outcomes of renal grafts from living related donors older than 60 years are acceptable, in terms of renal function and patient/graft survival. Material and methods: One hundred and forty-seven patients who received kidneys from donor age ≥60 years constituted the study group (group 1). The control group (group 2) consisted of 1310 patients who received renal transplants from donor age <60 years. Outcome measures included graft, patient survival, acute rejection rate and serum creatinine (SCr) in patients/donors. Graft and patient survivals were compared using the Kaplan–Meier method. Results: The mean age of donors was 62.7 ± 3.39 years in group 1 and 43.45 ± 9.65 years in group 2. Patient survival at 1, 3 and 5 years was 95.7%, 89.4% and 82.6% in group 1 and 93.8%, 89.1% and 83.1% in group 2 (p = 0.785), respectively. Death-censored graft survival at 1, 3 and 5 years was 98.5%, 94.8% and 94.8% in group 1 and 96.1%, 92.9% and 89% in group 2 (p = 0.166), respecti...

Outcome of renal transplantation from older living donors compared to younger living donor in developing country

To study the impact of parent-to-child transplant and older donor age on recipients' post-transplant creatinine levels, a total of 236 patients who received living donor kidney transplantation were evaluated for kidney viability based on creatinine (Cr) level. Of the 236 pairings, 113 (48%) were parent-to-child followed by sibling transplants (66, 30%). Recipient Cr levels were significantly higher at 6 months and 3 years post-transplant in the parent-to-child transplants compared to other donor-recipient relationships. In addition, donor age (average age: 44.1 ± 11.5; range: 19-66) contributed to higher recipient post-transplant Cr levels (p < 0.01). Pre-transplant donor and recipient Cr levels tended to result in higher post-transplant Cr levels in recipients (p < 0.05). Multivariate logistic regression analysis revealed that the presence of both parent-to-child transplant and older donor significantly increased the risk of elevated post-transplant Cr levels in recipients with an estimated odds ratios ranging from 3.46 (95% CI: 1.71-6.98) at 6 months to 8.04 (3.14-20.56) at 3 years post-transplant. Donor age significantly affected transplant survival as measured by higher recipient post-transplant Cr levels. In addition, parent-to-child transplant pairings, along with older donor age, significantly increased the risk of elevated post-transplant Cr levels in recipients.

Effect of donor age and parent-to-child transplant on living-related donor kidney transplantation: a single center's experience of 236 cases.

Background Kidney transplantation (KT) is the most effective treatment of end-stage renal disease (ESRD). Using grafts from aged donors is increasing worldwide. Our aim was to better understand the safety and effectiveness of aged living donors. Methods First, 482 cases with living-related kidney transplantation were analyzed retrospectively. The cases were divided into 2 groups by donor age ≥55 years (aged donor group, 136 cases) and  Results The mean donor estimated glomerular filtration rate (eGFR) was lower in the aged donor group compared with in the young donor group. After KT, the mean eGFR of the graft in the recipient was also lower in the aged donor group than in the young donor group. To confirm the effect of aged kidney grafts on renal function, we measured proteinuria. Compared with the young donor group, in the aged donor group incidence of proteinuria and 24-hour urinary protein were significantly higher. However, the incidence of delayed graft function was not significantly different between the 2 groups. We found that aged kidney grafts had no significant effect on long-term patient and graft survivals. Conclusions With the current lack of organs, aged kidney grafts are an acceptable alternative. Use of organs from aged donors safely expands the living donor pool.

Midterm Outcome of Living-Related Kidney Transplantation From Aged Donors: A Single-Center Experience

OBJECTIVES This study sought to determine whether recipients of grafts from donors aged 60 years or older achieve the same benefit as those from younger donors in the long term. MATERIALS AND METHODS Between January 2004 and July 2008, one hundred seventeen living renal transplants were performed. The patients were divided into an older donor group (aged ≥ 60 y, n=23) and a younger donor group (aged .05). The 1-, 3-, and 5-year graft survival for the older group versus the younger group was 95.7% versus 97.9% (P > .05), 91.3% versus 93.6% (P > .05), and 81.8% versus 83.3% (P > .05). Patient survival at 1, 3, and 5 years was 100% versus 100% (P > .05), 95.7% versus 96.8% (P > .05), and 90.9% versus 88.9% (P > .05) with no significant difference in the log-rank test for Kaplan-Meier. CONCLUSIONS Our studies suggest that in the long term, renal transplant from live donors older than 60 years it is an acceptable alternative.

Luoyan Yang

Papers

Long-term results of renal transplant from living donors aged over 60 years.