Kidney Transplant Centers Research Articles

Follow-Up Factors Contribute to Immunosuppressant Adherence in Kidney Transplant Recipients.

PurposeFollow-up and immunosuppressive medication (ISM) adherence are both important for kidney transplant recipients postoperatively and whether follow-up factors affect the ISM adherence remains unclear. The aim of this study was to examine the relationship between follow-up factors and ISM adherence, and the factors associated with ISM adherence.Patients and MethodsAn internet-based cross-sectional survey was conducted in a single kidney transplant center in China. The participants completed the internet-based questionnaire and the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS©) from January 12 to January 26, 2021.ResultsFinally, 288 (66.7%) participants responded to this survey. The percentage of full adherence to immunosuppressant was 51.7% (149/288), with 33.3% of the participants reporting a problem in timing dimension. We found that follow-up with a fixed doctor was significantly positive to good adherence (OR=2.124, 95% CI=1.111–4.062, P=0.023) after analyzing the survey data. Time since kidney transplantation and number of non-immunosuppressants were both associated with immunosuppressant adherence. No significant difference was found regarding the effect of the follow-up adherence on ISM adherence.ConclusionOur study demonstrated an insufficient prevalence of adherence to immunosuppressant in Chinese renal transplant recipients and revealed that follow-up with a fixed doctor may be a way to improve the patients’ ISM adherence. This anonymous internet-based survey provides valuable insight into the actual adherence rate, factors associated with non-adherence, and situations that may improve medication-taking.

Long-term renal and cardiovascular outcome of living kidney donors: A single-center retrospective observation study

BackgroundThe nephrectomy for donation reduces the renal parenchyma and glomerular filtration rate (GFR). It is important to understand the clinical consequences of kidney donation by a living donor.MethodsIn this single-center, observational, retrospective study, we defined the renal and cardiovascular outcomes of living kidney donors. We analyzed data of 124 donors who donated at the Kidney Transplant Center (TC) of Bari between February 2002 and December 2018. Biometric data collected at visit 0, that is, at the time of the study of the donor candidate, and at visit 1, or rather at the last nephrological checkup (October-2018/August-2019) were compared.ResultsAn overall drop in GFR of 29 mL/min was observed over the analyzed period of 81+/-59 months. At visit 1, two donors developed chronic renal failure, including one in ESKD who underwent a kidney transplant. No relationship between age at donation and GFR drop was found. A trend toward an increase in obese people was reported; 28% of patients had compensated dyslipidemia and 35% were treated for hypertension. During the follow-up time, 3% had major cardiovascular events and 24% were lost to follow-up. One patient died.ConclusionThe age of the donor does not represent a basic element for reducing GFR or for the occurrence of major cardiovascular events. Furthermore, older donor candidates, in optimal health, should not be excluded from the donation. It is important to promote careful and timely follow-up of the donor, preventing the most common clinical consequences of nephrectomy, in consideration of the poor compliance of a large part of donors over the long-term post-donation period.

Risk factors for delayed kidney graft function from a deseased donor

Aim. To determine statistically significant risk factors for delayed renal graft function. To assess the impact of delayed kidney graft function on the development of other complications, graft and recipient survival.Material and methods. In 237 consecutive kidney transplant recipients (from June 2018 to December 2021), we assessed its function in the early postoperative period. Delayed function was considered to be the need for hemodialysis in the first week after surgery. Among the donor factors, the type of donor, age, body mass index, the presence of vasopressor support, the time the donor was in intensive care, and the maximum level of creatinine during the follow-up were evaluated. Recipient risk factors include age, gender, body mass index, presence/absence and amount of urine, presence of preformed anti-HLA antibodies and/or repeated kidney transplantation, number of mismatches for six HLA antigens, number of mismatches for HLA-DR, presence and type of renal replacement therapy, etiology of end stage kidney disease. Among the perioperative risk factors are the duration of cold preservation, the time of second warm ischemia, the volume of intraoperative blood loss, the intraoperatively determined renal arterial resistive index of the renal graft, and the maximum concentration of tacrolimus in the first 4 days after kidney transplantation. After that the relationship between the presence of delayed kidney graft function and the development of early postoperative complications was assessed and its effect on the long-term survival of grafts and recipients was analyzed.Results. Out of 237 cases, 9 showed no function of the transplanted kidney, and therefore the grafts were removed. The incidence of delayed renal graft function was 24.5% (58/237). According to the results of a univariate analysis, a statistically significant relationship with the development of delayed kidney graft function had donor body mass index (p=0.019), male gender of the recipient (p=0.048), recipient body mass index (p=0.038), amount of urine (p=0.003), anuria (p=0.002), presence of preformed antibodies (p=0.025), repeated transplantation (p=0.002), time of second warm ischemia (p=0.036), intraoperative renal arterial resistive index (p=0.004) and maximum tacrolimus concentration in the first 4 days (p=0.022). In the multivariate model, donor body mass index >30 kg/m2 and peak tacrolimus concentration >23 ng/mL in the first 4 days were statistically significant (p=0.018 and p=0.025, respectively). A trend towards statistical significance was noted in the presence of oligoanuria before kidney transplantation (p=0.066) and resistance index >0.75 after surgery (p=0.056). One-year renal transplant survival in the absence and presence of delayed kidney graft function was 92.4% and 87.7%, two-year survival was 89.4% and 76.1%, respectively. The effect of delayed kidney graft function on graft survival was statistically significant (p=0.01), while overall recipient survival did not differ between the groups.Conclusion. During the univariate analysis, we identified 9 statistically significant factors, of which at least 3 are potentially modifiable. In the multivariate model, the most significant modifiable risk factor was an increased concentration of tacrolimus, which prompted the authors to reconsider the existing immunosuppressive protocol at the City Clinical Hospital n.a. S.P. Botkin. We consider the search for modifiable statistically significant risk factors for patients, their analysis and implementation of preventive measures to be an important task for each kidney transplant center.

Analysis of Risk Factors for Delayed Graft Function After Kidney Transplantation

Delayed graft function (DGF) is a serious complication associated with worsening outcomes in kidney transplantation. To facilitate DGF risk reduction, this study aimed to identify the incidence and modifiable risk factors of this condition in kidney transplant patients. This retrospective chart review included 220 patients who underwent kidney transplants between 2012 and 2021 at our kidney transplant center. Delayed graft function was defined as the requirement of hemodialysis within a week of transplantation. Clinical data from patients with DGF and those without this condition were compared to identify risk factors of DGF. Of 205 eligible patients, 20 (9.76%) developed DGF. In the univariate analysis, high hemoglobin level, deceased-donor type, and longer warm and cold ischemic times were significantly associated with DGF (P < .05). In the variable selection in logistic regression analysis, high hemoglobin level, with a cutoff value of 11.35 g/dL, and deceased-donor transplants were associated with higher DGF incidence (P < .05 for both factors). Our findings newly demonstrated that DGF occurred more frequently in patients with hemoglobin level >11.35 g/dL. As such, improvement in kidney transplantation outcomes could be achieved by reducing this modifiable risk factor.

211.16: Effect on Kidney Transplant Allocation With the Implementation of Concentric Circles Liver Allocation Policy: Impact of Simultaneous Liver Kidney Transplantation

Introduction: Although the new acuity circle allocation (ACA) policy has had an improvement in liver transplant (LT) rates in the United States, its effect on other solid organ transplants is unknown. The ACA has likely resulted in institutional and regional changes in the distribution of deceased donor kidneys as well, especially in the setting of simultaneous liver kidney (SLK) transplantation. We sought to review SLK patterns before and after the institution of ACA and determine if SLK rate changes were associated with a change in kidney transplant (KT) rates and patient and graft survival. Methods: Data from the Scientific Registry of Transplant Recipients (SRTR) was analyzed to evaluate rates of SLK transplantation before and after the implementation of ACA. Era 1 was defined as January 1, 2018 to February 3, 2020; Era 2 was defined as February 4, 2020 to June 1, 2021. Statistical comparisons between eras were performed. Transplant programs were divided into high (25%ile), medium (26-74%ile), and low volume (75%ile) KT programs according to Era 1. Similarly, transplant programs were divided into high (25%ile), medium (26-74%ile), and low volume (75%ile) SLK programs according to Era 1. Transplant volume was assessed for Era 2. Results: We analyzed 28,085 SLK and 75,058 KT performed in adult recipients from January 1, 2018 to June 1, 2021; 16,799 SLK and 45,168 KT were performed in Era 1 and 11,286 SLK and 29,890 KT were performed in Era 2. For SLK recipients during Era 1, the 1- and 3-year patient survival was 90.3% and 75.9%, respectively; the 1- and 3-year graft survival was 97.4% and 96.8%, respectively. During Era 2, the 1-year patient and graft survival for SLK recipients was 85.8% and 97.5%, respectively. For KT recipients during Era 1, the 1- and 3-year patient survival was 97.1% and 87.6%, respectfully; graft survival was 97.5% and 93.1%, respectively. During Era 2, the 1-year patient and graft survival for KT recipients was 93.2% and 96.9%, respectively. As a result of ACA, 1,008 additional kidneys went to SLK recipients. Changes in volume were most evident for low-volume SLK centers with an increase of 8 additional transplants, medium-volume SLK centers (increase of 1.2) and high-volume centers (increase of 4.6); while KT programs generally lost KT with low-volume KT centers with a decrease of 1.7 transplants, medium-volume KT centers (decrease of 1.5) and high-volume centers (decrease of 67). Conclusion: The institution of the ACA led to differing acceptance practices for SLK recipients with a net efflux of kidneys from solitary KT recipients. Interestingly, patient survival decreased while graft survival improved for SLK recipients while both patient and graft survival decreased for KT as a result of ACA.

423.7: Impact of Single Centre 440 Kidney Exchange Transplantation Over 20 Years to Increase Living Donor Pool in India: A Cohort Study

Introduction: In a living donor kidney transplantation (LDKT) dominated transplant program, kidney exchange may be a cost-effective and valid alternative strategy to increase LDKT in countries with limited resources where deceased donation kidney transplantation (DDKT) is in the initial stages. There is a data scarcity of challenges and solutions for kidney exchange in the developing world. Here, we report our experience of 440 single-center kidney exchange transplantation to increase LDKT in India. Methods: The study has been reviewed by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the Declaration of Helsinki as well as the Declaration of Istanbul. All donor-recipient pairs (DRP) gave their informed consent prior to their inclusion in the study. All pairs exchange kidneys of similar quality. Results: Between January 2000 and February 2020, 6050 LDKT and 925 DDKT were performed at our single-center, 440 using kidney exchanges (8.5%) (350 male, 90 female recipients, and 345 female and 95 male donors). The reasons for joining kidney exchange among transplanted patients were ABO incompatibility (n = 313), sensitization (n = 88), and better HLA matching (n = 39). All donors were near relatives [wife (n=236), husband (n=58), mother (n=93), father (n=25), sister (n=11), brother (n=8), grand-parents (n=2), son (n=1) and others (n=6)]. There were 164 two-way (n =328), 23 three-way (n = 69), 4 four-way (n = 16), 1 five-way (n=5), 2 six-way and one ten-way kidney exchange (n = 12). The state of residence of DRP was our state (Gujarat=246), and other states (n=144). There was an overwhelming preponderance of female donors (wife and mother) but similar to our LDKT program. The graft survival, patient survival, biopsy-proven rejection rate, and graft function was similar to other LDKT outcomes. It is important to recognize that over the 20 years our kidney exchange program has evolved into a large, advanced program with innovative approaches to further increase LDKT. We credit the success of our kidney exchange program to maintaining a registry of incompatible pairs, counseling on kidney exchange, a high-volume LDKT program, and teamwork. Conclusions: Kidney exchange is legal, cost-effective, and rapidly growing for facilitating LDKT with incompatible donors. This study provides large-scale evidence for the expansion of single-center LDKT via kidney exchange when national programs do not exist.

347.1: Unraveling the Stage-Shift of Acute Rejection in Renal Allografts

Introduction: The lack of accuracy in current allograft monitoring methodologies for allograft monitoring underscores a critical unmet need for more accurate immunosurveillance to uncover the flux in alloimmunity. QSant – a non-invasive, urine based multi-analyte diagnostic test – was clinically validated to prognosticate injury, risk of evolution, and resolution of acute rejection. QScore—the composite score across measurements of DNA markers: the amount of cell-free DNA, fraction of methylated cfDNA, protein and metabolic biomarkers in the QSant assay—enables this risk prognostication. This study now explores the clinical utility of QSant across the alloimmunity gradient of 32–100 for the early diagnosis of allograft injury and rejection. Methods: Utilizing a large real-world dataset of contemporaneous kidney allograft biopsy and QSant data from 11 US kidney transplant centers, the QScore offers a dynamic view into the changing state of allograft injury and rejection in response to alterations in the patients’ immunosuppression regimen. First analysis included Q-Score distributions in the biopsy-paired validation (n = 162) and prediction (n = 91) data from the Yang cohort, which were collected between 2010 and 2018 [10]. Second was a new analysis of a real-world data (RWD) cohort, comprising of prospectively collected urine samples (n = 235). Results: The RWD cohort (n = 235) of both adult and pediatric renal transplant patients demonstrated a spectrum across the Q-Score distribution. Specifically, 37.9% of the samples were enriched for immune quiescence (Q-Score < 32); the remaining 62.1% were enriched for the injury/rejection spectrum (Q-Score ≥ 32). The QScore <32 classifies stable allograft recipients; QScore between 32-55 exposes a state of alloimmunity flux; and the score between 55-100 provides advanced alloimmunity. Serial monitoring by QSant across a subset of 32 patients (RWD cohort,) over a period of two consecutive quarters (timepoints 1 and 2), captures the essence of the alloimmunity flux (p-value: 0.086 by non-parametric Wilcoxon test). Patients in the immunoquiescent domain (31% [10/32]) by and large continue to be stable (with Q-Scores that track at <32) 22% [7/32]). However, 9.4% (3/32) of patients show Q-Score drifts above 32 with evidence of early rejection. Patients in the alloimmune injury domain follow three trajectories: i) a planar gradient in QScore across time, showing persistence of alloimmunity; ii) an increasing gradient, delineating patients moving into the mature acute rejection domain; iii) a decreasing gradient, delineating patients moving into the immunoquiescent domain, putatively in response to immunomodulation following assessment of active rejection (Figure 1). Conclusion: The observed alloimmunity flux suggested precision monitoring with QSant has the potential to differentiate higher-grade acute rejection episodes from sub-clinical rejection, thereby improving a transplant recipient’s’ quality of life.

P8.079: Systematic Review and Meta-Analysis on the Effect of Blood Transfusions on Kidney Transplant Outcomes: Shining New Light on an Age-Old Debate

Introduction: Since the 1970’s, the use of transfusions in kidney transplant medicine has been a point of contention. While they are a solution to the anaemia plaguing this patient population and in 1978 were shown to lead to a dose-dependent improvement in graft survival, they also have the ability to induce a sensitized state, increasing the risk for poorer graft outcomes. Influenced by the inherent risk, clinicians have begun to administer transfusions based on clinical need as opposed to deliberately. Furthermore, the popularity and efficacy of tacrolimus as an immunosuppressant over the past two decades, has allowed for a degree of standardization across different kidney transplant centres. The majority of the studies in the past two decades have focused on previously understudied postoperative blood transfusions, occurring in 40-60% of cases. No systematic reviews or meta-analyses have been published including these newer studies. With these details in mind we believed it prudent to undertake a systematic review and meta-analysis exploring the effect transfusions have on transplant outcomes. Methods: A systematic search was conducted using MEDLINE, Embase, Cochrane library and Clinicaltrals.gov. Including only English articles published between 1/1/2000 and 01/03/2022, we found 9 studies that met our inclusion criteria. A meta-analysis was thereby carried out for three outcomes, delayed graft function (DGF), the development of de novo donor specific antibodies, and antibody mediated rejection (AMR). Results: Low-level evidence exists for no difference or an increase in DGF and AMR for participants who received at least one blood transfusion. Low-level evidence exists for an increase in AMR for participants who received at least one blood transfusion. For the outcomes not included in the meta-analysis (graft loss/failure, graft survival, acute rejection, development of HLA-Abs, sepsis), each of the included studies reported either no difference or a detrimental effect on the outcomes. No study reported any improvement with blood transfusion usage. Conclusion: The transfusion effect appears not to exist in the 21st century even in patients receiving postoperative blood transfusions. However, while transfusions are avoided wherever possible and despite a myriad of replacements becoming available, transfusions in kidney transplant recipients do not appear to be associated with any worse outcomes compared to their non transfused counterparts. While more research is required, clinicians may be able to administer blood transfusions to kidney transplant patients with a clear conscience.

P8.065: COVID-19 and Pediatric Kidney Transplantation: Iberoamerican Multicentric Study

Introduction: Concern on the effect of COVID-19 in children recipients of kidney transplant (KT) lead to an initial decline in the transplantation activity. Our aim is to present graft and clinical outcomes of a multicenter cohort of pediatric KT performed during COVID-19 pandemic and compare it with an historic control group. Our secondary goal is to report the clinical evolution of children who suffered COVID-19 after transplantation. Methods: A retrospective analysis in seven pediatric KT centers of Iberoamerica, from January 2019 to December 2020 was done. In the included institutions, 168 pediatric KT were performed: 97 patients were control group (year 2019) and 71 the study group (year 2020). Baseline demographics and comorbidities were comparable. Graft outcome showed no significant differences in terms of the need of post transplant renal replacement therapy and glomerular filtration rate in the last visit. Graft hydronephrosis, urinary tract infection, and other complications were similar (Table 1). Results: Six (8,4%) out of 71 patients transplanted in 2020 developed COVID 19 after the transplant. The infection occurred at a mean 71,8 days after the transplant (range: 5-214 days). Three patients were asymptomatic, two presented with fever and one with cough. Three patients were managed on an outpatient basis, two were admitted but remain in a common room, whereas one child required hospitalization in intensive care unit but, without the need of mechanical ventilatory assistance. In 3 patients mycophenolate was suspended, and in the other 3 there were no changes in the immunosuppressive scheme. There were no mayor respiratory complications such as COVID-19 pneumonia or acute respiratory distress syndrome. Hospital stay was a mean of 13 days (range: 0-39). All six patients had good graft outcome, with no need renal replacement therapy, with a mean glomerular filtration rate of 86,36 mL/min/1.73 m2 (range:58 -126). One patient had recurrence of original renal disease. Conclusion: Despite initial concerns about the increased risk of severe complications of COVID-19 and the graft survival in children with KT, our multicentric series showed similar initial graft outcome and no mayor respiratory complications. Longer follow up is needed to assess the long-term evolution of these grafts and patients.

P10.01: How Did the War Affect Organ Transplantation in Syria?

Since 2011, the Syrian conflict has destroyed much of the country’s infrastructure. The deteriorating humanitarian situation has involved health workers and facilities. In 2010, before the war, 385 kidney transplants were performed in Syria. This number declined to 154 in 2013 (60% less) before increasing to 251 transplants in 2018, which is still 35% less than the number of transplants performed before the war. In addition, the number of operational kidney transplant centers has decreased from 8 in 2010, distributed over 3 cities, to only 4 in 2013, all located in Damascus, which increased to 6 centers in 2019. Interestingly, with regard to type of living donor, the percentage of unrelated kidney donors has decreased by 20% for unclear reasons. Another alarming statistic is that more than 50% of kidney transplant physicians and surgeons are no longer practicing transplant medicine in their centers, either because they have left the country or because their centers had become nonoperational. Since the war, free and timely provision of immunosuppressive drugs for all patients in all provinces has been a leading challenge for health authorities and transplant patients. This difficulty has led to adverse medical consequences for patients. A project to initiate liver transplant came to a halt because of complex reasons but mainly because foreign trainers could not visit Syria. Although the autologous bone marrow transplant program had slowed until recently, it has become more active, involving both autologous and allogeneic transplants. The deceased-donor program is still not available in Syria; the war has just reinforced the many reasons that prevented the start of this program before the conflict. The commitment of transplant teams despite these large challenges continues to be extraordinary. The Syrian conflict has affected all aspects of organ transplant, paralyzing new projects and negatively affecting existing programs.

Perioperative fluid management and associated complications in children receiving kidney transplants in the UK

BackgroundIntravenous fluid administration is an essential part of perioperative care for children receiving a kidney transplant. There is a paucity of evidence to guide optimal perioperative fluid management. This study aimed to identify the volume of perioperative fluids administered across 5 UK paediatric kidney transplant centres and explore associations between fluid volume administered, graft function, and fluid-related adverse events.MethodsData were collected from five UK paediatric kidney transplant centres on perioperative fluid volumes administered, and incidence of pulmonary oedema, systemic hypertension, and requirement for intensive care support. Children < 18 years of age who received a kidney-only transplant between 1st January 2020 and 31st December 2021 were included.ResultsComplete data from 102 children were analysed. The median total volume of fluid administered in 72 h was 377 ml/kg (IQR 149 ml/kg) with a high degree of variability. A negative relationship between total fluid volume administered and day 7 eGFR was noted (p < 0.001). Association between urine volume post-transplant and day 7 eGFR was also negative (p < 0.001). Adverse events were frequent but no significant difference was found in the fluid volume administered to those who developed an adverse event, vs those who did not.ConclusionsThis study describes a high degree of variability in perioperative fluid volumes administered to children receiving kidney transplants. Both fluid volume and urine output were negatively associated with short-term graft function. These data contrast traditional interpretation of high urine output as a marker of graft health, and highlight the need for prospective clinical trials to optimise perioperative fluid administration for this group.Graphical A higher resolution version of the Graphical abstract is available as Supplementary information

Telemedicine services for living kidney donation: A US survey of multidisciplinary providers

Individuals considering living kidney donation face geographic, financial, and logistical challenges. Telemedicine can facilitate healthcare access/care coordination. Yet difficulties exist in telemedicine implementation and sustainability. We sought to examine centers' practices and providers' attitudes toward telemedicine to improve services for donors. We surveyed multidisciplinary providers from 194 active adult US living donor kidney transplant centers; 293 providers from 128 unique centers responded to the survey (center representation rate = 66.0%), reflecting 83.9% of practice by donor volume and 91.5% of US states/territories. Most centers (70.3%) plan to continue using telemedicine beyond the pandemic for donor evaluation/follow‐up. Video was mostly used by nephrologists, surgeons, and psychiatrists/psychologists. Telephone and video were mostly used by social workers, while video or telephone was equally used by coordinators. Half of respondent nephrologists and surgeons were willing to accept a remote completion of physical exam; 68.3% of respondent psychiatrists/psychologists and social workers were willing to accept a remote completion of mental status exam. Providers strongly agreed that telemedicine was convenient for donors and would improve the likelihood of completing donor evaluation. However, providers (65.5%) perceived out‐of‐state licensing as a key policy/regulatory barrier. These findings help inform practice and underscore the instigation of policies to remove barriers using telemedicine to increase living kidney donation.

The Kidney Transplant Equity Index

To develop a scalable metric which quantifies kidney transplant (KT) centers' performance providing equitable access to KT for minority patients, based on the individualized prelisting prevalence of end-stage renal disease (ESRD). Racial and ethnic disparities for access to transplant in patients with ESRD are well described; however, variation in care among KT centers remains unknown. Furthermore, no mechanism exists that quantifies how well a KT center provides equitable access to KT for minority patients with ESRD. From 2013 to 2018, custom datasets from the United States Renal Data System and United Network for Organ Sharing were merged to calculate the Kidney Transplant Equity Index (KTEI), defined as the number of minority patients transplanted at a center relative to the prevalence of minority patients with ESRD in each center's health service area. Markers of socioeconomic status and recipient outcomes were compared between high and low KTEI centers. A total of 249 transplant centers performed 111,959 KTs relative to 475,914 nontransplanted patients with ESRD. High KTEI centers performed more KTs for Black (105.5 vs 24, P <0.001), Hispanic (55.5 vs 7, P <0.001), and American Indian (1.0 vs 0.0, P <0.001) patients than low KTEI centers. In addition, high KTEI centers transplanted more patients with higher unemployment (52 vs 44, P <0.001), worse social deprivation (53 vs 46, P <0.001), and lower educational attainment (52 vs 43, P <0.001). While providing increased access to transplant for minority and low socioeconomic status populations, high KTEI centers had improved patient survival (hazard ratio: 0.86, 95% confidence interval: 0.77-0.95). The KTEI is the first metric to quantify minority access to KT incorporating the prelisting ESRD prevalence individualized to transplant centers. KTEIs uncover significant national variation in transplant practices and identify highly equitable centers. This novel metric should be used to disseminate best practices for minority and low socioeconomic patients with ESRD.

The role of bypass filters in deceased donor kidney allocation in the United States

Kidney transplant centers set organ offer filters enabling all candidates at their center to be bypassed during allocation of deceased donor kidneys from the UNOS Organ Center. These filters aim to increase allocation efficiency by preemptively screening out offers unlikely to be accepted. National data were used to compare filter settings of 175 centers in 2007 and in 2019. We examined characteristics of centers whose settings became increasingly restrictive over time, and associations between filter settings and organ offer acceptance. Overall, centers became more open to receiving offers over time, from a median 62% of filters open to receiving national offers in 2007 to 73% in 2019. Intravenous drug use filter settings changed most, from 63 to 153 willing centers. Centers with more open filter settings had higher transplant volume and offer acceptance ratios across all risk categories despite preemptively screening out fewer offers compared to centers with less open settings, but similar transplant rates. There was significant geographic heterogeneity in the distribution of centers with more open filter settings. Current center bypass filters may impact patients' access to transplantation without achieving their full potential for improving allocation efficiency.

Early Post-Transplant Red Blood Cell Transfusion Is Associated With an Increased Risk of Transplant Failure: A Nationwide French Study.

BackgroundRed blood cell (RBC) transfusions are frequently required in the early period after kidney transplantation. However, the consequences of RBC transfusions on long-term outcomes are largely unrecognized.MethodsWe conducted a nationwide French cohort study involving all 31 French kidney transplant centers. Patients having received a first kidney transplant between January 1, 2002 and December 31, 2008 were identified through the national registry of the French BioMedecine Agency (Agence de BioMédecine). Number and date of RBC transfusions were collected from the national database of the French transfusion public service. The primary endpoint was transplant failure defined as graft loss or death with a functional graft.ResultsAmong 12,559 patients included during the study period, 3,483 (28%) were transfused during the first 14 days post-transplant. Median follow-up was 7.6 (7.5-7.8) years. Multivariable analysis determined that post-transplant RBC transfusion was associated with an increased risk in transplant failure (HR 1.650, 95%CI [1.538;1.771] p<0.0001). Both sensitivity and propension score analyses confirmed the previous result.ConclusionsEarly red blood cell transfusion after kidney transplantation is associated with increased transplant failure.

Analysis of risk factors for impaired wound healing after kidney transplantation.

To analyse risk factors for impaired wound healing after kidney transplantation to guide clinical decision-making. A retrospective analysis was performed on patients who received kidney transplantation from January 1, 2019, to May 1, 2021, at Kidney Transplantation Center in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine. A case-control study was used to identify a cohort of patients with similar baseline characteristics according to 1:4 ratio. Patients were divided into two groups according to whether there was impaired wound healing after surgery. The basic data and clinical examinations between the two groups were compared, and the risk factors for impaired wound healing after kidney transplantation were analysed using univariate and multivariate analyses. According to the data type, independent samples t-test or Chi-squared test was used for comparison between groups. Furthermore, multivariate logistic regression analysis was used to analyse different risk factors and calculate the odds ratio (OR) and 95% confidence interval (CI) of each factor. A total of 18 patients showed impaired wound healing after kidney transplantation. And we conducted 72 statically matched controls. Age, diabetes, transplant types, body mass index (BMI), albumin, haemoglobin, and wound infection were statistically different between the two groups. The factors with statistically significant differences in univariate analysis were included in multivariate logistic regression analysis. The results showed that BMI > 25, fasting blood glucose level, albumin level, and prealbumin level were independent risk factors for impaired wound healing after kidney transplantation. Risk factors for impaired wound healing after kidney transplantation can be detected after surgery. Strengthening postoperative monitoring and early intervention of recipients with such factors may effectively prevent impaired wound healing after kidney transplantation.

Donor Nephrectomy Through Mini-Flank Incision: A Single-Centre Experience Among Nigerian Patients.

Background and objectiveThe field of kidney transplantation in sub-Saharan Africa is still in the rudimentary stages. The majority of patients with chronic kidney disease have no access to renal replacement therapy, leading to very high mortality rates. Donor nephrectomy (DN) is an important aspect of kidney transplantation. Over the last two decades, open DN (ODN) has given way to minimally invasive techniques like laparoscopic DN (LDN) and robotic-assisted DN. In this study, we aimed to describe our experience with mini-flank incision donor nephrectomy (MIDN) at a Nigerian renal transplant center.Materials and methodsWe conducted a retrospective review of all DN cases performed at a single Nigerian kidney transplantation center over a three-year period. Information obtained from these patients was classified into pre-, intra-, and postoperative. The data included sociodemographic characteristics, preoperative preparation, details of intraoperative techniques, and postoperative findings. These were entered into a proforma and analyzed using SPSS Statistics version 21 (IBM Corp., Armonk, NY).ResultsA total of 230 patients underwent ODN during the study period. The majority of the donors were males (92.8%) with a mean age of 30.83 ±8.43 years. The body mass index (BMI) of most (76.1%) of the donors was within the normal range (18.5-24.9 kg/m2). The duration of DNs ranged from 72 to 154 minutes with a mean duration of 130 ±28 minutes. The length of flank incisions ranged from 7.8 to 12 cm with a mean incision length of 10.8 ±1.0 cm. Donors who had MIDN attained satisfactory postoperative pain control with about 90% of them having a BMI of <30 kg/m2. Oral intake and ambulation were commenced on the first postoperative day, and the cosmetic outcomes were deemed acceptable in over 90% of kidney donors.ConclusionMini-incision for DN through the flank approach is a suitable alternative to LDN in the developing world where facilities and skills for LDN or robotic nephrectomies are largely unavailable. It offers a short recovery time, early ambulation, and excellent allograft outcomes.

Prevalence of anti-HLA antibodies in highly sensitized kidney transplant candidates

Introduction: Kidney transplantation is the standard gold therapy for the treatment of the majority of end-stage renal diseases (ESRDs). Despite the general success rate of allogeneic transplantation due to immunosuppressive therapy, it is difficult to find an appropriate donor for some sensitized patients. Objectives: This study aimed to estimate the prevalence and titers of anti-HLA-class I and anti-HLA-class II antibodies in sensitized patients in a kidney transplantation center. The history of the risk factors of sensitization was studied. Patients and Methods: Twenty highly sensitized ESRD patients with a calculated panel-reactive antibody (CPRA) ≥50% were selected, and anti-HLA-I and anti-HLA-II antibodies were assessed in their sera using a single antigen bead (SAB) Luminex assay. Results: The previous history of kidney transplantation was the most critical sensitization risk factor. The results indicated that HLA A*24:02 and DQA1*02:01/DQB1*06:02 were the most frequent antibodies in class I and class II, respectively. Moreover, the mean fluorescence intensity (MFI) levels of anti-HLA class II antibodies were significantly higher than the MFI levels of anti-HLA class I antibodies. Conclusion: According to the findings of this study, matching HLA alleles, particularly class II molecules, can reduce sensitization in the first kidney transplant. A better understanding of the sensitization status of transplant candidates could be gained by examining CPRA values.

MO988: Malignancy After Kidney Transplantation: A Two-Center Experience

Abstract BACKGROUND AND AIMS Kidney transplantation (KT) is the preferred treatment option for patients with end-stage renal disease (ESRD) as it provides better patient survival and quality of life. While longer graft survival is maintained with potent immunosuppressive drugs used to prevent allograft rejection, de novo malignancy development after transplantation has become a substantial issue. In this study, we aimed to investigate the incidence and risk factors of post-transplant malignancy in kidney transplant recipients, including its demographic, clinical and laboratory features. METHOD A retrospective cohort study was conducted at two tertiary care kidney transplant centers in the same province. We recruited adult (&amp;gt;18 years of age) kidney transplant recipients who underwent kidney transplantation between 1986 and 2020. We excluded KT recipients who lost to follow-up in the early post-transplant period and/or with incomplete records. Malignancies that occurred after graft failure were also excluded. Kidney transplant recipients with malignancy were matched to KT recipients without malignancy using a 1:1 ratio. RESULTS In this study, 2750 eligible patients were reviewed for the development of malignancy after kidney transplantation. A total of 278 KT recipients (10.1%) had biopsy confirmed malignancies during the follow-up period. The median post-transplant follow-up time was 217 months (IQR: 148–290 months). The most common malignancies were nonmelanoma skin cancer (28.8%), urinary tract cancer (16.5%), Kaposi's sarcoma (9.7%), gastrointestinal tract cancer (6.5%) and post-transplant lymphoproliferative disease (6.5%). The median time from kidney transplantation to the diagnosis of malignancy was 127 months (IQR: 62–198 months). In comparison to the control group, patients with malignancy were older (P ≤ 0.001), had a higher family history of malignancy (P ≤ 0.001), had a greater history of smoking (P = 0.005), and usage of erythropoietin in the pre-transplant period was higher (P ≤ 0.001). There was no significant difference between the two groups in terms of gender and the type of induction therapy. Overall mortality was higher in patients with malignancy (OR: 2.491 [CI: 1.586–3.912], P &amp;lt; 0.001). CONCLUSION The most common malignancy in kidney transplant recipients was found to be non-melanoma skin cancer. Elderly recipients, patients with a family history of malignancy and patients using erythropoietin in the pre-transplant period should be closely monitored for the development of malignancy.

Long-term outcomes and prognostic factors in kidney transplant recipients in Jakarta, Indonesia: a cohort study

ObjectivesTo determine the long-term survival rates and prognostic factors in kidney transplant (KT) recipients in Jakarta, Indonesia.DesignRetrospective cohort study.SettingA KT centre in Jakarta.ParticipantsWe enrolled 754 consecutive adult recipients who underwent...