Journal ArticleDOI
Early Outcomes of the New UK Deceased Donor Kidney Fast-Track Offering Scheme.
Chris J. Callaghan,Lisa Mumford,Laura Pankhurst,Richard Baker,J. Andrew Bradley,Christopher J.E. Watson +5 more
TLDR
Although KFTS kidneys have less favorable donor, graft, and recipient risk factors than NKAS kidneys, short-term graft and patient outcomes are acceptable and national schemes that identify and rapidly offer kidneys at high risk of discard may contribute to minimizing the unnecessary discard of organs.Abstract:
BACKGROUND The UK Kidney Fast-Track Scheme (KFTS) was introduced in 2012 to identify kidneys at high risk of discard and to rapidly facilitate transplantation. A retrospective analysis of kidneys transplanted through the KFTS was undertaken. METHODS UK Transplant Registry data were collected on deceased donor kidneys implanted between November 1, 2012, and April 30, 2015, (donation after brain death [DBD] donors) and March 1, 2013, and April 30, 2015 (donation after circulatory death [DCD] donors). Posttransplant outcomes included 1-year estimated glomerular filtration rate and death-censored graft survival (DCGS). RESULTS Over the study period, 523 deceased donor kidneys were transplanted through the KFTS and 4174 via the standard National Kidney Allocation Scheme (NKAS). Kidneys in the KFTS were more likely to be from older diabetic donors, had a higher frequency of poor ex vivo perfusion, had longer cold ischemic times, and were transplanted into older recipients. One-year DCGS of KFTS and NKAS DBD donor kidneys was similar (94% vs 95%; P = 0.70), but for DCD donor kidneys, DCGS was lower in those allocated via the KFTS (91% versus 95%; P = 0.04). Median 1-year estimated glomerular filtration rate for DBD donor kidneys was lower in those allocated via the KFTS (49 vs 52 mL/min per 1.73 m; P = 0.01), but for DCD kidneys, there was no difference (45 vs 48 mL/min per 1.73 m; P = 0.10). CONCLUSIONS Although KFTS kidneys have less favorable donor, graft, and recipient risk factors than NKAS kidneys, short-term graft and patient outcomes are acceptable. National schemes that identify and rapidly offer kidneys at high risk of discard may contribute to minimizing the unnecessary discard of organs.read more
Citations
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Journal ArticleDOI
Recipient and allograft survival following donation after circulatory death versus donation after brain death for renal transplantation: A systematic review and meta-analysis.
TL;DR: The short- and long-term survival graft and patient benefits are similar between DCD and DBD kidney transplants, demonstrating that large, controlled DCD kidney programmes are urgently needed worldwide in order to increase the number of kidney transplanted patients.
Journal ArticleDOI
Organ utilization - the next hurdle in transplantation?
TL;DR: Current guidelines must be clear to allow and support sensible decisions and recognition that graft failure or inadvertent disease transmission are not necessarily attributable to poor decision‐making.
Journal ArticleDOI
Implementation of donation after circulatory death kidney transplantation can safely enlarge the donor pool: A systematic review and meta-analysis.
Elsaline Rijkse,Sebastiaan Ceuppens,Hongchao Qi,Jan N. M. IJzermans,Dennis A. Hesselink,Robert C. Minnee +5 more
TL;DR: In this article, a systematic review and meta-analysis was performed to investigate donation after circulatory death (DCD) graft outcomes compared to donation after brain death (DBD), and the results showed that long-term DCD kidney transplant outcomes are similar to DBD despite a higher risk of PNF, DGF, and a 13% increased risk of graft loss in the first year after transplantation.
Journal ArticleDOI
Prospective Validation of Prediction Model for Kidney Discard.
Sheng Zhou,Allan B. Massie,Allan B. Massie,Courtenay M. Holscher,Madeleine M. Waldram,Tanveen Ishaque,Alvin G. Thomas,Dorry L. Segev,Dorry L. Segev +8 more
TL;DR: Prioritizing allocation of high-PODD kidneys to centers that are more likely to transplant them might help reduce kidney discard.
Journal ArticleDOI
Renal transplant from infant and neonatal donors is a feasible option for the treatment of end‐stage renal disease but is associated with increased early graft loss
Imeshi Wijetunga,C. Ecuyer,Sonsoles Martinez-Lopez,Muhammad Jameel,Richard Baker,Matthew Welberry Smith,Chirag Patel,Michael Weston,Niaz Ahmad +8 more
TL;DR: The data show that kidney transplantation from such donors is a feasible option at centers with experience of EKT, albeit with increased risk of early graft loss, whereas in the ≤5 kg donor category significant improvement was seen at 12 months compared to 3 months after transplantation.
References
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Journal ArticleDOI
A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index.
Panduranga S. Rao,Douglas E. Schaubel,Mary K. Guidinger,Kenneth A. Andreoni,Robert A. Wolfe,Robert M. Merion,Friedrich K. Port,Randall S. Sung +7 more
TL;DR: The graded impact of KDRI on graft outcome makes it a useful decision-making tool at the time of the deceased donor kidney offer, and it is likely that there is a considerable overlap in the KDRI distribution by expanded and nonexpanded criteria donor classification.
Journal ArticleDOI
Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors.
Friedrich K. Port,Jennifer L. Bragg-Gresham,Robert A. Metzger,Dawn M. Dykstra,Brenda W. Gillespie,Eric W. Young,Francis L. Delmonico,James J. Wynn,Robert M. Merion,Robert A. Wolfe,Philip J. Held +10 more
TL;DR: By identifying donor factors associated with graft failure, these analyses may help to expand the number of transplanted kidneys by increasing the utilization of retrieved cadaveric kidneys.
Journal ArticleDOI
Kidney donation after circulatory death (DCD): state of the art
Dominic M. Summers,Dominic M. Summers,Christopher J.E. Watson,Gavin J. Pettigrew,Rachel J. Johnson,David Collett,James Neuberger,J. Andrew Bradley +7 more
TL;DR: An updated, extended UK registry analysis is presented showing that longer-term transplant outcomes in DCD donor kidneys are also similar to those for DBD donor kidneys, and that transplant outcomes for kidneys from expanded-criteria DCD donors are no less favorable than for expanded-Criteria DBD donors.
Journal ArticleDOI
Determinants of Discard of Expanded Criteria Donor Kidneys: Impact of Biopsy and Machine Perfusion
Randall S. Sung,Laura L. Christensen,Alan B. Leichtman,S. M. Greenstein,Dale A. Distant,James J. Wynn,Mark D. Stegall,Francis L. Delmonico,Friedrich K. Port +8 more
TL;DR: Biopsy findings and machine perfusion are important correlates of ECD kidney discard; corresponding associations with graft failure require further study.
Journal ArticleDOI
Effect of donor age and cold storage time on outcome in recipients of kidneys donated after circulatory death in the UK: a cohort study
Dominic M. Summers,Dominic M. Summers,Dominic M. Summers,Rachel J. Johnson,Alex Hudson,David Collett,Christopher J.E. Watson,Christopher J.E. Watson,J. Andrew Bradley,J. Andrew Bradley +9 more
TL;DR: Kidneys from older circulatory-death donors have equivalent graft survival to kidneys from brain- death donors in the same age group, and are acceptable for transplantation, and this finding should be considered when developing organ allocation policy.