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Astha Gupta, George Francos, Adam M Frank, Ashesh P Shah
BACKGROUND: Efforts have been made to maximize the utility of each organ transplanted. Policy changes to capture unrealized graft years have been implemented utilizing the kidney donor profile index (KDPI). Understanding the impact of KDPI on long-term graft function is critical to an informed organ acceptance decision. METHODS: We reviewed the records of 309 consecutive deceased adult donor kidney recipients who underwent kidney transplantation at our center. We obtained KDPI of the allografts directly from United Network for Organ Sharing (UNOS) and patients were divided into four categories: KDPI ≤ 20, KDPI 21 - 35, KDPI 36 - 85, and KDPI > 85...
October 2016: Clinical Nephrology
Francesca M Dimou, Hemalkumar B Mehta, Deepak Adhikari, Robert C Harland, Taylor S Riall, Yong-Fang Kuo
BACKGROUND: Nonalcoholic steatohepatitis is expected to become the leading indication for liver transplantation. Use of extended criteria donors (ECD) may help with donor allocation in these patients. The objective of this study was to determine the use of ECDs in patients with nonalcoholic steatohepatitis undergoing liver transplantation to stimulate a liver-specific predictive model for ECD use. METHODS: The United Network for Organ Sharing database was used to identify patients undergoing liver transplantation for nonalcoholic steatohepatitis (2002-2014)...
August 20, 2016: Surgery
Colleen L Jay, Kenneth Washburn, Patrick G Dean, Ryan A Helmick, Jacqueline A Pugh, Mark D Stegall
BACKGROUND: Given high dialysis mortality rates for patients >60 years old, accepting a kidney with a high kidney donor profile index (KDPI) score could enable earlier and potentially preemptive transplantation (preKT). However, evidence regarding the risks of high KDPI allografts in older patients is limited. Our objective was to determine the relative benefit for older patients of KDPI>85% transplant either preemptively or not compared with remaining on the waitlist. METHODS: UNOS data from 2003-2012 for adult deceased donor kidney transplant candidates was analyzed to evaluate patient survival in patients >60 years old for preKT and non-preKT KDPI>85% transplants compared to candidates remaining on the waitlist including patients who received KDPI 0-85% transplants according to multivariate Cox regression models...
August 4, 2016: Transplantation
Mona D Doshi, Peter P Reese, Isaac E Hall, Bernd Schröppel, Joseph Ficek, Richard N Formica, Francis L Weng, Rick D Hazs, Heather Thiessen Philbrook, Chirag Parikh
BACKGROUND: Kidneys with "high" kidney donor profile index (KDPI) are often biopsied and pumped, yet frequently discarded. METHODS: In this multicenter study, we describe the characteristics and outcomes of kidneys with KDPI ≥80 that were procured from 338 deceased donors. We excluded donors with anatomical kidney abnormalities. RESULTS: Donors were categorized by the number of kidneys discarded: 1) none (n=154, 46%), 2) 1 discarded and 1 transplanted (n=48, 14%), 3) both discarded (n=136, 40%)...
August 3, 2016: Transplantation
Ronald P Pelletier, Todd E Pesavento, Amer Rajab, Mitchell L Henry
BACKGROUND: Deceased donor (DD) kidney quality is determined by calculating the Kidney Donor Profile Index (KDPI). Optimizing high KDPI (≥85%) DD transplant outcome is challenging. This retrospective study was performed to review our high KDPI DD transplant results to identify clinical practices that can improve future outcomes. METHODS: We retrospectively calculated the KDPI for 895 DD kidney recipients transplanted between 1/2002 and 11/2013. Age, race, body mass index (BMI), retransplantation, gender, diabetes (DM), dialysis time, and preexisting coronary artery disease (CAD) (previous myocardial infarction (MI), coronary artery bypass (CABG), or stenting) were determined for all recipients...
August 2016: Clinical Transplantation
Raymond L Heilman, Amit Mathur, Maxwell L Smith, Bruce Kaplan, Kunam S Reddy
This review will concentrate on the literature regarding donor kidneys that are currently being utilized at a relatively low rate. Donors with AKI seem to have outcomes equivalent to those without AKI provided one can rule out significant cortical necrosis. Donors with pre-existing diabetes or hypertension may have a marginally lower aggregate survival, but still provide a significant benefit over remaining on the wait list. As KDPI only derives an aggregate association with survival with a very modest C statistic, the data would indicate that this should not be the sole reason to discard a kidney except perhaps in patients with extremely low EPTS scores...
May 12, 2016: American Journal of Transplantation
Jagbir Gill, Jianghu Dong, Caren Rose, John S Gill
Concern about the long-term impact of delayed graft function (DGF) may limit the use of high-risk organs for kidney transplantation. To understand this better, we analyzed 29,598 mate kidney transplants from the same deceased donor where only 1 transplant developed DGF. The DGF associated risk of graft failure was greatest in the first posttransplant year, and in patients with concomitant acute rejection (hazard ratio: 8.22, 95% confidence interval: 4.76-14.21). In contrast, the DGF-associated risk of graft failure after the first posttransplant year in patients without acute rejection was far lower (hazard ratio: 1...
June 2016: Kidney International
Yousef Al-Shraideh, Umar Farooq, Hany El-Hennawy, Alan C Farney, Amudha Palanisamy, Jeffrey Rogers, Giuseppe Orlando, Muhammad Khan, Amber Reeves-Daniel, William Doares, Scott Kaczmorski, Michael D Gautreaux, Samy S Iskandar, Gloria Hairston, Elizabeth Brim, Margaret Mangus, Robert J Stratta
AIM: To compare outcomes between single and dual en bloc (EB) kidney transplants (KT) from small pediatric donors. METHODS: Monocentric nonprospective review of KTs from pediatric donors ≤ 5 years of age. Dual EB KT was defined as keeping both donor kidneys attached to the inferior vena cava and aorta, which were then used as venous and arterial conduits for the subsequent transplant into a single recipient. Donor age was less useful than either donor weight or kidney size in decision-making for kidney utilization as kidneys from donors < 8 kg or kidneys < 6 cm in length were not transplanted...
March 24, 2016: World Journal of Transplantation
J J Snyder, N Salkowski, A Wey, A K Israni, J D Schold, D L Segev, B L Kasiske
There is a perception that transplanting high-risk kidneys causes programs to be identified as underperforming, thereby increasing the frequency of discards and diminishing access to transplant. Thus, the Organ Procurement and Transplantation Network (OPTN) has considered excluding transplants using kidneys from donors with high Kidney Donor Profile Index (KDPI) scores (≥0.85) when assessing program performance. We examined whether accepting high-risk kidneys (KDPI ≥0.85) for transplant yields worse outcome evaluations...
September 2016: American Journal of Transplantation
S Bae, A B Massie, X Luo, S Anjum, N M Desai, D L Segev
Since March 26, 2012, the Kidney Donor Profile Index (KDPI) has been provided with all deceased-donor kidney offers, with the goal of improving the expanded criteria donor (ECD) indicator. Although an improved risk index may facilitate identification and transplantation of marginal yet viable kidneys, a granular percentile system may reduce provider-patient communication flexibility, paradoxically leading to more discards ("labeling effect"). We studied the discard rates of the kidneys recovered for transplantation between March 26, 2010 and March 25, 2012 ("ECD era," N = 28 636) and March 26, 2012 and March 25, 2014 ("KDPI era," N = 29 021) using Scientific Registry of Transplant Recipients (SRTR) data...
July 2016: American Journal of Transplantation
Michael S Martin, Michael E Hagan, Darla K Granger
BACKGROUND: The United Network for Organ Sharing began including the Kidney Donor Profile Index (KDPI) March 26, 2012 and began a new allocation scheme December 1, 2014. METHODS: Kidney donors from our organ procurement organization from March 2012 to December 2014 were reviewed. The KDPIs of all 919 kidney only transplants were compared with all 102 kidney/extrarenal transplants. RESULTS: The average KDPI for kidney alone allografts was 47 (range 1 to 100) (standard deviation = 25...
March 2016: American Journal of Surgery
William F Parker, J Richard Thistlethwaite, Lainie Friedman Ross
BACKGROUND: The new deceased donor kidney allocation algorithm uses a Kidney Donor Profile Index (KDPI) based on donor characteristics to predict graft survival and divides kidneys into 4 quality groups (ie, KDPI-A, -B, -C, and -D). Pediatric kidneys constitute 10% to 12% of deceased donor kidneys. We hypothesized that KDPI would not accurately predict pediatric donor graft survival and superior predictive models could be created. METHODS: Scientific Registry of Transplant Recipients data for years 2000 to 2010 for transplants from child (<10 years) and adolescent (10-17 years inclusive) donors into first-time adult recipients were analyzed with graft failure as the principle outcome...
January 12, 2016: Transplantation
Christopher C Stahl, Koffi Wima, Dennis J Hanseman, Richard S Hoehn, Audrey Ertel, Emily F Midura, Samuel F Hohmann, Ian M Paquette, Shimul A Shah, Daniel E Abbott
BACKGROUND: The desire to provide cost-effective care has lead to an investigation of the costs of therapy for end-stage renal disease. Organ quality metrics are one way to attempt to stratify kidney transplants, although the ability of these metrics to predict costs and resource use is undetermined. METHODS: The Scientific Registry of Transplant Recipients database was linked to the University HealthSystem Consortium Database to identify adult deceased donor kidney transplant recipients from 2009 to 2012...
December 2015: Surgery
A J Matas, J M Smith, M A Skeans, B Thompson, S K Gustafson, D E Stewart, W S Cherikh, J L Wainright, G Boyle, J J Snyder, A K Israni, B L Kasiske
A new kidney allocation system, expected to be implemented in late 2014, will characterize donors on a percent scale (0%-100%) using the kidney donor profile index (KDPI). The 20% of deceased donor kidneys with the greatest expected posttransplant longevity will be allocated first to the 20% of candidates with the best expected posttransplant survival; kidneys that are not accepted will then be offered to remaining 80% of candidates. Waiting time will start at the time of maintenance dialysis initiation (even if before listing) or at the time of listing with an estimated glomerular filtration rate of 20 mL/min/1...
January 2015: American Journal of Transplantation
Alison P K Lee, Daniel Abramowicz
The allocation of deceased donor kidneys has become more complex because of the increasing spectrum of donors and recipients age and comorbidities. Several scoring systems have been proposed to evaluate the donor quality of deceased donor kidneys, based on clinical, pathological or combined parameters to predict the risk of renal allograft failure. Nonetheless, besides the dichotomous extended criteria donor (ECD) score, none of the others have been used in clinical practice because of numerous reasons, ranging from lack of robust validation to the technical challenges associated with the evaluation of donor biopsies...
August 2015: Nephrology, Dialysis, Transplantation
A Gupta, G Chen, B Kaplan
No abstract text is available yet for this article.
November 2014: American Journal of Transplantation
I Gandolfini, C Buzio, P Zanelli, A Palmisano, E Cremaschi, A Vaglio, G Piotti, L Melfa, G La Manna, G Feliciangeli, M Cappuccilli, M P Scolari, I Capelli, L Panicali, O Baraldi, S Stefoni, A Buscaroli, L Ridolfi, A D'Errico, G Cappelli, D Bonucchi, E Rubbiani, A Albertazzi, A Mehrotra, P Cravedi, U Maggiore
Pretransplant donor biopsy (PTDB)-based marginal donor allocation systems to single or dual renal transplantation could increase the use of organs with Kidney Donor Profile Index (KDPI) in the highest range (e.g. >80 or >90), whose discard rate approximates 50% in the United States. To test this hypothesis, we retrospectively calculated the KDPI and analyzed the outcomes of 442 marginal kidney transplants (340 single transplants: 278 with a PTDB Remuzzi score<4 [median KDPI: 87; interquartile range (IQR): 78-94] and 62 with a score=4 [median KDPI: 87; IQR: 76-93]; 102 dual transplants [median KDPI: 93; IQR: 86-96]) and 248 single standard transplant controls (median KDPI: 36; IQR: 18-51)...
November 2014: American Journal of Transplantation
A B Massie, X Luo, E K H Chow, J L Alejo, N M Desai, D L Segev
The Kidney Donor Profile Index (KDPI) has been introduced as an aid to evaluating deceased donor kidney offers, but the relative benefit of high-KDPI kidney transplantation (KT) versus the clinical alternative (remaining on the waitlist until receipt of a lower KDPI kidney) remains unknown. Using time-dependent Cox regression, we evaluated the mortality risk associated with high-KDPI KT (KDPI 71-80, 81-90 or 91-100) versus a conservative, lower KDPI approach (remain on waitlist until receipt of KT with KDPI 0-70, 0-80 or 0-90) in first-time adult registrants, adjusting for candidate characteristics...
October 2014: American Journal of Transplantation
Roland A Hernandez, Sayeed K Malek, Edgar L Milford, Samuel R G Finlayson, Stefan G Tullius
BACKGROUND: The Kidney Donor Profile Index (KDPI) is a more precise donor organ quality metric replacing age-based characterization of donor risk. Little prior attention has been paid on the outcomes of lower-quality kidneys transplanted into elderly recipients. Although we have previously shown that immunological risks associated with older organs are attenuated by advanced recipient age, it remains unknown whether risks associated with lower-quality KDPI organs are similarly reduced in older recipients...
November 27, 2014: Transplantation
Ajay K Israni, Nicholas Salkowski, Sally Gustafson, Jon J Snyder, John J Friedewald, Richard N Formica, Xinyue Wang, Eugene Shteyn, Wida Cherikh, Darren Stewart, Ciara J Samana, Adrine Chung, Allyson Hart, Bertram L Kasiske
In 2013, the Organ Procurement and Transplantation Network in the United States approved a new national deceased donor kidney allocation policy that introduces the kidney donor profile index (KDPI), which gives scores of 0%-100% based on 10 donor factors. Kidneys with lower KDPI scores are associated with better post-transplant survival. Important features of the new policy include first allocating kidneys from donors with a KDPI≤20% to candidates in the top 20th percentile of estimated post-transplant survival, adding waiting time from dialysis initiation, conferring priority points for a calculated panel-reactive antibody (CPRA)>19%, broader sharing of kidneys for candidates with a CPRA≥99%, broader sharing of kidneys from donors with a KDPI>85%, eliminating the payback system, and allocating blood type A2 and A2B kidneys to blood type B candidates...
August 2014: Journal of the American Society of Nephrology: JASN
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