Read by QxMD icon Read


J Reinier F Narvaez, Jing Nie, Katia Noyes, Mary Leeman, Liise K Kayler
Understanding risk factors for deceased-donor kidney non-transplantation is important since discard rates remain high. We analyzed DonorNet® data of consecutive deceased-donor non-mandatory 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 non-transplantation at our or subsequent transplant centers. Exclusions were HCV/HBV, 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
KDRI introduced in 2009 included Hepatitis C serologic but not viremic status of the donors. With NAT testing 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 12/5/2014 to 12/31/2016 with the KDRI score and HCV Ab and NAT testing status obtained from UNOS database. The 205 aviremic Hep C Ab+ NAT - kidney transplants were compared to KDRI matched control kidneys that were Hep C Ab-NAT-...
February 16, 2018: American Journal of Transplantation
David Axelrod, Mark A Schnitzler, Huiling Xiao, William Irish, Elizabeth Tuttle-Newhall, Su-Hsin Chang, Bertram L Kasiske, Tarek Alhamad, Krista L Lentine
Kidney transplant is the optimal therapy for end stage renal disease, prolonging survival and reducing healthcare spending. Prior economic analyses of kidney transplant using Markov models, have generally assumed compatible, low risk, donors. The economic implications of using deceased donor kidneys with high kidney donor profile index (KPDI) scores, ABO incompatible or HLA incompatible living donors has not been assessed. The costs of transplant and dialysis were compared using discrete event simulation over a 10-year period, using data from the United States Renal Data System, Vizient ™ (Irving, Texas), and literature review...
February 16, 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 goals 1 ...
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 (sequence A≤20%, B>20-<35%, C≥35-≤85%, 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: HRQOL 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% 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 OPTN/UNOS database, we identified recipients of DDK from 2000 to 2013 with ≥85% KDPI. From this cohort, three groups of mate-kidney recipients were identified based on CIT: group 1 (≥24vs...
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, and the impact KDPI on transplant outcomes for both donor after cardiac death (DCD) and donor after brain death (DBD) ...
January 3, 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...
August 21, 2017: Nephrology, Dialysis, Transplantation
Burcin Ekser, Richard S Mangus, Chandrashekhar A Kubal, John A Powelson, Jonathan A Fridell, William C Goggins
The positive impact of delayed kidney transplantation (KT) on patient survival for combined liver-KT (CLKT) has already been demonstrated by our group. The purpose of this study is to identify whether the quality of the kidneys (based on KDPI) or the delayed approach KT contributes to improved patient survival. 130 CLKT were performed between 2002-2015; 69 with simultaneous KT (Group S) and 61 with delayed KT (Group D) (performed as a second operation with a mean cold ischemia time [CIT] of 50±15h). All patients were categorized according to the KDPI score; 1-33%, 34-66%, and 67-99%...
September 19, 2017: Liver Transplantation
Andrew Wey, Nicholas Salkowski, Walter K Kremers, Cory R Schaffhausen, Bertram L Kasiske, Ajay K Israni, Jon J Snyder
We developed a kidney offer acceptance decision tool to predict the probability of graft survival and patient survival for first-time kidney-alone candidates after an offer is accepted or declined, and we characterized the effect of restricting the donor pool with a maximum acceptable kidney donor profile index (KDPI). For accepted offers, Cox proportional hazards models estimated these probabilities using transplanted kidneys. For declined offers, these probabilities were estimated by considering the experience of similar candidates who declined offers and the probability that declining would lead to these outcomes...
September 19, 2017: American Journal of Transplantation
S M Nazarian, A W Peng, B Duggirala, M Gupta, T Bittermann, S Amaral, M H Levine
Kidney Allocation System (KAS) was enacted in 2014 to improve graft utility, while facilitating transplantation of highly-sensitized patients and preserving pediatric access to high-quality kidneys. Central to this system is the Kidney Donor Profile Index (KDPI), a metric intended to predict transplant outcomes based on donor characteristics but derived using only adult donors. We posited that KAS had inadvertently altered the profile and quantity of kidneys made available to pediatric recipients. This question arose from our observation that most pediatric donors carry a KDPI over 35 and have therefore been rendered relatively inaccessible to pediatric recipients under KAS...
August 14, 2017: American Journal of Transplantation
D E Stewart, V C Garcia, M I Aeder, D K Klassen
The Kidney Donor Profile Index (KDPI) became a driving factor in deceased donor kidney allocation on December 4, 2014, with the implementation of the kidney allocation system (KAS). On April 20, 2016, the annual recalibration of the Kidney Donor Risk Index into KDPI was incorrectly programmed in DonorNet, resulting in erroneously high KDPI values, by between 1 and 21 percentage points (e.g. actual KDPI of 70% was displayed as 86%). The error was corrected on May 19, 2016, <24 h after being recognized. During this 30-day period, the distribution of recipients largely resembled pre-KAS patterns...
May 28, 2017: American Journal of Transplantation
Dimitris Bertsimas, Jerry Kung, Nikolaos Trichakis, David Wojciechowski, Parsia A Vagefi
BACKGROUND: When a deceased-donor kidney is offered to a waitlisted candidate, the decision to accept or decline the organ relies primarily upon a practitioner's experience and intuition. Such decisions must achieve a delicate balance between estimating the immediate benefit of transplantation and the potential for future higher-quality offers. However, the current experience-based paradigm lacks scientific rigor and is subject to the inaccuracies that plague anecdotal decision-making...
December 2017: Transplantation
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"