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B Chopra, K K Sureshkumar
BACKGROUND: Donor final serum creatinine (SCr) is a dynamic variable and is 1 of 10 factors used in calculating kidney donor profile index (KDPI). We hypothesize that deceased-donor kidneys (DDKs) with higher SCr were likely accepted for transplantation if procurement biopsy findings were favorable and with long-term outcomes no worse than kidneys with lower final SCr within a KDPI group. METHODS: Using the Organ Procurement and Transplant Network/United Network for Organ Sharing database, we identified DDK transplant recipients from 2000 to 2015 who received induction and calcineurin inhibitor/mycophenolate mofetil maintenance...
March 12, 2018: Transplantation Proceedings
Gregor Rehse, Fabian Halleck, Dmytro Khadzhynov, Lukas J Lehner, Anna Kleinsteuber, Anja Staeck, Michael Duerr, Klemens Budde, Oliver Staeck
Background: Recently, a risk index for living donor kidney (LDK) transplantation [living kidney donor profile index (LKDPI)] was proposed to compare LDKs with each other and with deceased donor kidneys (DDKs). Until now, the LKDPI has not been validated externally. Methods: This long-term retrospective analysis included 1305 consecutive adult kidney transplant recipients who were transplanted 2000-16 in our centre. The Kidney Donor Profile Index (KDPI) was calculated in 889 DDKs and the LKDPI in 416 LDKs...
May 9, 2018: Nephrology, Dialysis, Transplantation
Muhammad A Khan, Hany El-Hennawy, Korie C Jones, David Harriman, Alan C Farney, Jeffrey Rogers, Giuseppe Orlando, Robert J Stratta
INTRODUCTION: Deceased donor (DD) kidneys exhibiting severe atherosclerosis involving the renal artery (RA) may represent a contraindication to kidney transplantation (KT). METHODS: Eversion endarterectomy (EE) was performed as a salvage procedure to permit KT. RESULTS: We identified 17 cases (1.2% of all DD KTs during the study period) involving EE of the DD RA. Thirteen (76.5%) kidneys were imported and mean Kidney Donor Profile Index (KDPI) was 81%...
May 8, 2018: Clinical Transplantation
Mary G Bowring, Allan B Massie, Rebecca Craig-Schapiro, Dorry L Segev, Lauren Hersch Nicholas
In the United States, the Centers for Medicare and Medicaid Services (CMS) use Systems Improvement Agreements (SIAs) to require transplant programs repeatedly flagged for poor-performance to improve performance or lose CMS funding for transplants. We identified 14 kidney transplant (KT) programs with SIAs and 28 KT programs without SIAs matched on waitlist volume and characterized kidney acceptance using SRTR data from 12/2006-3/2015. We used difference-in-differences linear regression models to identify changes in acceptance associated with an SIA independent of program variation and trends prior to the SIA...
May 2, 2018: American Journal of Transplantation
Lukas Johannes Lehner, Anna Kleinsteuber, Fabian Halleck, Dmytro Khadzhynov, Eva Schrezenmeier, Michael Duerr, Kai-Uwe Eckardt, Klemens Budde, Oliver Staeck
Background: Recently, transplant societies have had to change their allocation policies to counter global organ shortages. However, strategies differ significantly and long-term outcomes and cross-regional applicability remain to be evaluated. Methods: Therefore, we retrospectively analysed the Kidney Donor Profile Index (KDPI) of 987 adult kidney transplants at our centre using data from the Organ Procurement and Transplantation Network (OPTN) as a reference. Results: In our cohort, the median KDPI was 66%, with a higher proportion of >85% KDPI kidneys compared with the US cohort (32...
March 30, 2018: Nephrology, Dialysis, Transplantation
J Reinier F Narvaez, Jing Nie, Katia Noyes, Mary Leeman, Liise K Kayler
Understanding risk factors for deceased-donor kidney nontransplantation is important since discard rates remain high. We analyzed DonorNet® data of consecutive deceased-donor nonmandatory share primary kidney-only offers to adult candidates at our center and beyond between July 1, 2015 and March 31, 2016 for donor- and system-level risk factors of discard, defined as nontransplantation at our or subsequent transplant centers. Exclusions were hepatitis C virus/hepatitis B virus core antibody status, blood type AB, and donor <1 year based on low candidate waitlist size...
March 2, 2018: American Journal of Transplantation
G Shekhtman, E Huang, G M Danovitch, P Martin, S Bunnapradist
In kidney-alone recipients, dual kidney transplantation (DKT) using "higher-risk" donor organs has shown outcomes comparable to those of single-kidney transplantation using expanded criteria donor (ECD) organs. To investigate the feasibility of a similar approach with combined kidney-liver transplantation, we identified 22 dual-kidney liver transplants (DKLT) and 3,044 single-kidney liver transplants (SKLT) performed in the United States between 2002 and 2012 using UNOS/OPTN registry data. We compared donor/recipient characteristics as well as graft/recipient survival between DKLT recipients and SKLT recipients of "higher-risk" kidneys [ECD and high kidney donor profile index (KDPI>85%) donors]...
March 1, 2018: Liver Transplantation
Shaifali Sandal, Xun Luo, Allan B Massie, Steven Paraskevas, Marcelo Cantarovich, Dorry L Segev
Background: The use of machine perfusion (MP) in kidney transplantation lowers delayed graft function (DGF) and improves 1-year graft survival in some, but not all, grafts. These associations have not been explored in grafts stratified by the Kidney Donor Profile index (KDPI). Methods: We analyzed 78 207 deceased-donor recipients using the Scientific Registry of Transplant Recipients data from 2006 to 2013. The cohort was stratified using the standard criteria donor/expanded criteria donor (ECD)/donation after cardiac death (DCD)/donation after brain death (DBD) classification and the KDPI scores...
February 20, 2018: Nephrology, Dialysis, Transplantation
Paolo Ferrari
Increased longevity matching using Kidney Donor Profile Index (KDPI) to optimize long-term kidney allograft survival has been central to the effort of appropriate allocation of deceased donor kidneys. The data by Helenterä and co-workers in this issue, who looked at predictors of early allograft loss, should prompt an analysis of whether predictors of short-term graft survival can improve KDPI-based decisions when considering whether to accept or decline a deceased donor kidney offer. This article is protected by copyright...
February 17, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
L Sibulesky, C E Kling, C Blosser, C K Johnson, A P Limaye, R Bakthavatsalam, N Leca, J D Perkins
Kidney Donor Risk Index (KDRI) introduced in 2009 included hepatitis C serologic but not viremic status of the donors. With nucleic acid amplification testing (NAT) now being mandatory, further evaluation of these donors is possible. We conducted a retrospective matched case-control analysis of adult deceased donor kidney transplants performed between December 5, 2014 to December 31, 2016 with the KDRI score and hepatitis C virus antibody (HCV Ab) and NAT testing status obtained from the United Network for Organ Sharing database...
February 16, 2018: American Journal of Transplantation
David A Axelrod, Mark A Schnitzler, Huiling Xiao, William Irish, Elizabeth Tuttle-Newhall, Su-Hsin Chang, Bertram L Kasiske, Tarek Alhamad, Krista L Lentine
Kidney transplantation is the optimal therapy for end-stage renal disease, prolonging survival and reducing spending. Prior economic analyses of kidney transplantation, using Markov models, have generally assumed compatible, low-risk donors. The economic implications of transplantation with high Kidney Donor Profile Index (KDPI) deceased donors, ABO incompatible living donors, and HLA incompatible living donors have not been assessed. The costs of transplantation and dialysis were compared with the use of discrete event simulation over a 10-year period, with data from the United States Renal Data System, University HealthSystem Consortium, and literature review...
May 2018: American Journal of Transplantation
David D Lee, Hani M Wadei
On December 4, 2014, the new kidney allocation system (KAS) was implemented to reduce extreme longevity mismatches between kidney allograft and recipient life expectancy, increase the highly sensitized patients' access to transplantation through prioritization, broaden access for disadvantaged candidates by counting dialysis time towards wait-list time, and potentially increase the utilization of "marginal kidneys" through broader allocation at the local and regional level. In the first year after implementation, the early results of KAS suggested that the new policies were successful in meeting many of these goals1 ...
February 12, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Rachel C Forbes, Irene D Feurer, David LaNeve, Beatrice P Concepcion, Christianna Gamble, Scott A Rega, C Wright Pinson, David Shaffer
BACKGROUND: The United Network for Organ Sharing system allocates deceased donor kidneys based on the kidney donor profile index (KDPI), stratified as sequences (A ≤ 20%, B > 20-<35%, C ≥ 35-≤85%, and D > 85%), with increasing KDPI associated with decreased graft survival. While health-related quality of life (HRQOL) may improve after transplantation, the effect of donor kidney quality, reflected by KDPI sequence, on post-transplant HRQOL has not been reported. METHODS: Health-related quality of life was measured using the eight scales and physical and mental component summaries (PCS, MCS) of the SF-36® Health Survey...
January 27, 2018: Clinical Transplantation
Marcelo S Sampaio, Bhavna Chopra, Amy Tang, Kalathil K Sureshkumar
The new kidney allocation system recommends local and regional sharing of deceased donor kidneys (DDK) with 86-100% Kidney Donor Profile Index (KDPI) to minimize discard. Regional sharing can increase cold ischemia time (CIT) which may negatively impact transplant outcomes. Using a same donor mate kidney model, we aimed to define a CIT that should be targeted to optimize outcomes. Using Organ Procurement and Transplant Network/United Network for Organ Sharing database, we identified recipients of DDK from 2000 to 2013 with ≥85% KDPI...
January 24, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Tiffany J Zens, Juan S Danobeitia, Glen Leverson, Peter J Chlebeck, Laura J Zitur, Robert R Redfield, Anthony M D'Alessandro, Scott Odorico, Dixon B Kaufman, Luis A Fernandez
INTRODUCTION: Renal transplant outcomes result from a combination of factors. Traditionally, donor factors were summarized by classifying kidneys as extended criteria or standard criteria. In 2014, the nomenclature changed to describe donor factors with the kidney donor profile index (KDPI). We aim to evaluate the relationship between KDPI and delayed graft function (DGF), and the impact KDPI on transplant outcomes for both donor after cardiac death (DCD) and donor after brain death (DBD)...
March 2018: Clinical Transplantation
Syed Ali Husain, Mariana C Chiles, Samnang Lee, Stephen O Pastan, Rachel E Patzer, Bekir Tanriover, Lloyd E Ratner, Sumit Mohan
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...
January 6, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Raimundo M García Del Moral Martín, Juan Antonio Retamero Díaz, Mercedes Cava Molina, Belen M Cobacho Tornel, Juan Bravo Soto, Antonio Osuna Ortega, Francisco O'Valle Ravassa
INTRODUCTION: KDRI / KDPI are tools use in kidney donor evaluation. It has been proposed as a substitute of, or complementary to preimplantation renal biopsy. These scores has not been validated in Spain. OBJECTIVE: 1) To investigate the concordance between KDPI and histological scores (preimplantation renal biopsy) and 2) To assess the relationship between KDRI, KDPI and histological score on graft survival in the expanded criteria donors group. METHODOLOGY: Retrospective cohort study from 1 January 1998 until 31 December 2010...
November 11, 2017: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Mary G Bowring, Courtenay M Holscher, Sheng Zhou, Allan B Massie, Jacqueline Garonzik-Wang, Lauren M Kucirka, Sommer E Gentry, Dorry L Segev
Transplant candidates who accept a kidney labeled increased risk for disease transmission (IRD) accept a low risk of window period infection, yet those who decline must wait for another offer that might harbor other risks or never even come. To characterize survival benefit of accepting IRD kidneys, we used 2010-2014 Scientific Registry of Transplant Recipients data to identify 104 998 adult transplant candidates who were offered IRD kidneys that were eventually accepted by someone; the median (interquartile range) Kidney Donor Profile Index (KDPI) of these kidneys was 30 (16-49)...
March 2018: American Journal of Transplantation
Lena Sibulesky, Catherine E Kling, Ajit P Limaye, Christopher K Johnson
The Kidney Donor Risk Index (KDRI) and Kidney Donor Profile Index (KDPI) assist clinicians with the selection of deceased donor kidneys. This scoring system is based on 10 donor factors including Hepatitis C virus (HCV) status from serological or NAT testing. The donor HCV status (i.e., having either a positive hepatitis C antibody (Ab) or nucleic acid testing (NAT) result) increases the hazard ratio for graft failure by 1.27 and the KDPI by approximately 20%. Whether this increase in KDPI is a true reflection of graft quality for HCV seropositive but not viremic donors is unknown...
November 6, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Ester Philipse, Alison P K Lee, Bart Bracke, Vera Hartman, Thierry Chapelle, Geert Roeyen, Kathleen de Greef, Dirk K Ysebaert, Gerda van Beeumen, Marie-Madeleine Couttenye, Amaryllis H Van Craenenbroeck, Rachel Hellemans, Jean-Louis Bosmans, Daniel Abramowicz
Background: The Kidney Donor Risk Index (KDRI) is a quantitative evaluation of the quality of donor organs and is implemented in the US allocation system. This single-centre study investigates whether the implementation of the KDRI in our decision-making process to accept or decline an offered deceased donor kidney, increases our acceptance rate. Methods: From April 2015 until December 2016, we prospectively calculated the KDRI for all deceased donor kidney offers allocated by Eurotransplant to our centre...
November 1, 2017: Nephrology, Dialysis, Transplantation
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