Kidney Transplant Outcomes Research Articles

Geographic variation in kidney failure and transplantation in Aotearoa New Zealand: A population-based data linkage study.

This study aimed to describe the epidemiology of kidney replacement therapy (KRT) in Aotearoa New Zealand and assess the impact of residential location on access to kidney transplantation. AcceSS and Equity in Transplantation (ASSET), a health-linked data platform, was used to identify people commencing KRT in New Zealand from 2006 to 2019 and analyse regional epidemiology. Health services were classified as 'transplanting', 'intermediate' or 'remote' depending on their degree of separation from a transplant centre. Multiple logistic regression modelling was used to assess the predictors of deceased donor waitlisting or living donor transplantation within 6 months after starting KRT. Web-based mapping software was used to develop interactive geospatial maps. The cohort was 7704 people newly starting KRT. Living in an intermediate [odds ratio (OR): 0.73 (95% confidence interval (CI): 0.61-0.88)] or remote [OR: 0.38 (95% CI: 0.27-0.54)) region and Māori (OR: 0.35 (95% CI: 0.28-0.44)], Pacific [OR: 0.32 (95% CI: 0.24-0.42)) and Asian (OR: 0.66 (95% CI: 0.50-0.87)] ethnicity were associated with a decreased likelihood of timely waitlisting or transplantation. Regional maps can be explored here. There is marked geospatial and ethnic variation in the epidemiology of kidney failure and access to kidney transplantation across New Zealand. Geospatial mapping of kidney failure epidemiology and transplantation outcomes can provide opportunities to direct resources towards populations at greatest need.

Improved survival prediction for kidney transplant outcomes using artificial intelligence-based models: development of the UK Deceased Donor Kidney Transplant Outcome Prediction (UK-DTOP) Tool

The UK Deceased Donor Kidney Transplant Outcome Prediction (UK-DTOP) Tool, developed using advanced artificial intelligence (AI), significantly enhances the prediction of outcomes for deceased-donor kidney transplants in the UK. This study analyzed data from the UK Transplant Registry (UKTR), including 29,713 transplant cases between 2008 and 2022, to assess the predictive performance of three machine learning models: XGBoost, Random Survival Forest, and Optimal Decision Tree. Among these, XGBoost demonstrated exceptional performance with the highest concordance index of 0.74 and an area under the curve (AUC) consistently above 0.73, indicating robust discriminative ability and calibration. In comparison to the traditional Kidney Donor Risk Index (KDRI), which achieved a lower concordance index of 0.57, the UK-DTOP model marked a significant improvement, underscoring its superior predictive accuracy. The advanced capabilities of the XGBoost model were further highlighted through calibration assessments using the Integrated Brier Score (IBS), showing a score of 0.14, indicative of precise survival probability predictions. Additionally, unsupervised learning via k-means clustering was employed to identify five distinct clusters based on donor and transplant characteristics, uncovering nuanced insights into graft survival outcomes. These clusters were further analyzed using Bayesian Cox regression, which confirmed significant survival outcome variations across the clusters, thereby validating the model’s effectiveness in enhancing risk stratification. The UK-DTOP tool offers a comprehensive decision-support system that significantly refines pre-transplant decision-making. The study’s findings advocate for the adoption of AI-enhanced tools in healthcare systems to optimize organ matching and transplant success, potentially guiding future developments in global transplant practices.

Impact of deceased-donor characteristics on early graft function: outcome of kidney donor pairs accepted for transplantation.

The impact of deceased donor characteristics on kidney transplant outcomes is controversial. Correspondingly, the predictive performance of deceased donor scores remains moderate, and many transplant centers lack validated criteria for graft acceptance decisions. To better dissect donor-related risk from recipient and periprocedural variables, we analyzed outcomes of kidney donor pairs transplanted in different individuals. This study explored (a)symmetry of early outcomes of 328 cadaveric kidney transplant recipients from 164 donor pairs transplanted at three Eurotransplant centers. The primary discriminatory factor was (a)symmetry of partner graft function, defined as early graft loss or impaired graft function [estimated glomerular filtration rate (eGFR) <30 mL/min] 3 months after transplantation. We reasoned that a relevant impact of donor factors would result in a high concordance rate of limited graft function or failure. The observed number of symmetric graft failure after transplantation was less than statistically expected (3 months: 1 versus 2, p = 0.89; and 12 months: 3 versus 5, p = 0.26). However, we found a trend toward an impaired 5-year graft survival of grafts with good function 3 months after transplantation but a failed or impaired partner graft compared to symmetrically well-functioning grafts (p = 0.09). Subsequently, we explored the impact of individual donor and recipient variables on early transplant outcomes. Generalized estimating equations after feature selection with LassoGEE bootstrap selected donor age, donor body mass index, and donor eGFR as the relevant risk factors. Our findings indicate that donor factors impact early outcomes in kidney transplantation but may have a limited role in long-term graft survival, once a graft has been accepted for transplantation. Utilizing donor-based clinical scores has the potential to aid clinicians in acceptance decisions, giving them an estimate of individual posttransplant outcomes. However, the ultimate decision for acceptance should rest with clinicians, who must consider the complex interplay of donor factors, as well as recipient and periprocedural characteristics.

Impact of Donor-Recipient Relationship on Long-Term Outcomes in Living-Related Donor Kidney Transplantation.

BACKGROUND This study aimed to evaluate the impact of the donor-recipient relationship on the long-term outcomes of living-related kidney transplantation (LRKT), a topic that has been previously underreported. MATERIAL AND METHODS A total of 598 LRKTs performed between 2001 and 2021were analyzed and classified into 5 groups based on the donor-recipient relationship: 228 from mothers (M-to-C), 160 from fathers (F-to-C), 115 from siblings, 55 from spouses, and 40 from offspring. Graft survival, postoperative complications within the first year, serum creatinine (Scr), and hazard ratio (HR) for all-cause graft loss were assessed. RESULTS The overall 1-, 3-, 5-, 7-, and 10-year graft survival rates were 96.0%, 92.4%, 86.4%, 79.9%, and 69.9%, respectively. The graft survival rate in the sibling group was slightly higher than those in the M-to-C and F-to-C groups, and the differences between the groups were insignificant. The survival rates of grafts donated by spouses and offspring were lower than in other groups, and the incidence of graft loss within the first postoperative year was higher in the offspring group. In comparison to the sibling group, spouse and offspring donations increased the graft loss risk (HR, 3.3; 95% CI, 1.6-6.9) and 3.8 (1.7-8.4), respectively, followed by M-to-C and F-to-C donations (HR, 1.9; 95% CI: 1.2-3.4) and 1.8 (1.1-3.1), respectively, which were associated with elevated postoperative Scr levels. CONCLUSIONS Spouse and offspring donations significantly increased the risk of graft loss compared to donations from siblings, followed by M-to-C and F-to-C pairings, which were associated with higher postoperative Scr levels.

Assessing the reliability of rapid frozen tissue sections from pre-transplant kidney biopsies in DCD donors and correlations with clinico-pathological data: a pilot study.

Compared to donations after brain death, donations after circulatory death present a series of difficulties: the acquisition of the family's consent, the need for qualified personnel and specific resources, death assessment, assessment of the organ, and graft care (pre- and post-transplant). These are all time-related factors that negatively impact the organ, resulting in increased tubular, glomerular, and vascular damage. The evaluation of the organ, as per today's standards, requires three hours for the preparation and processing of formalin-fixed paraffin-embedded (FFPE) samples. An alternative to this is the use of the extemporaneous frozen biopsy. However, frozen samples are considered a second choice in the decision-making process. This retrospective study investigates the reliability of the frozen samples in identifying a series of morphological alterations compared to the more accepted results from FFPE samples. Additionally, two important clinical data, terminal serum creatinine levels and warm ischemia time, were correlated to the presence of some morphological alterations in an attempt to find effective and fast strategies to predict the kidney transplant outcome.

Outcomes of kidney transplantation in recipients with SARS-cov-2 infection: a 282-case single-center experience in Japan.

The coronavirus disease 2019, caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has become a global epidemic. There are concerns regarding the severity of SARS-CoV-2 infections in kidney transplant (KTx) recipients. However, there is limited data on how the epidemic has affected the treatment and prognosis of these patients. Therefore, we aimed to report the changes in the treatment and outcomes of KTx recipients infected with SARS-CoV-2 during each wave at our institution. A total of 282 KTx recipients who were infected with SARS-CoV-2 during the study period were followed up at Tokyo Women's Medical University between March 2020 and August 2022. We investigated the outcomes and treatments of infected KTx recipients. Nineteen (6.7%) patients showed severe outcomes, including eight SARS-CoV-2 infection-related deaths. Risk factors associated with severe outcomes included underlying conditions, such as diabetes mellitus, heart disease, and liver disease (odds ratios, 2.09, 2.88, and 5.52, respectively). Treatment strategies changed throughout the epidemic in response to changes in the SARS-CoV-2 variants. Antiviral drugs were gradually administered as soon as they were approved for use. Treatment strategies for KTx recipients were gradually established over the course of the epidemic. Although the proportion of infected KTx recipients decreased compared to that of the general population throughout the epidemic, many patients still followed a severe course.

Clinical Characteristics and Outcomes of Kidney Transplantation in Patients with Autosomal Dominant Polycystic Kidney Disease

Clinical Characteristics and Outcomes of Kidney Transplantation in Patients with Autosomal Dominant Polycystic Kidney Disease

Outcomes of Kidney Transplantation from Deceased Diabetic Donors

Outcomes of Kidney Transplantation from Deceased Diabetic Donors

Impact of Probiotic Supplementation on Kidney Transplantation Outcomes

Impact of Probiotic Supplementation on Kidney Transplantation Outcomes

Impact of Delayed Graft Function on Kidney Transplant Outcomes

Impact of Delayed Graft Function on Kidney Transplant Outcomes

Kidney Transplant Outcomes in Patients with BMI of 35 or Greater: Should We Be Doing More? A Single-Center Experience

Kidney Transplant Outcomes in Patients with BMI of 35 or Greater: Should We Be Doing More? A Single-Center Experience

Kidney Transplantation Outcomes by Dialysis Modality in an Underserved Population

Kidney Transplantation Outcomes by Dialysis Modality in an Underserved Population

Influence of Recipient Education on the Outcome of Simultaneous Pancreas and Kidney Transplantation

Influence of Recipient Education on the Outcome of Simultaneous Pancreas and Kidney Transplantation

Examining Insurance-Related Disparities in Kidney Transplantation Access and Outcomes: A Systematic Review and Bibliometric Analysis

Examining Insurance-Related Disparities in Kidney Transplantation Access and Outcomes: A Systematic Review and Bibliometric Analysis

Comparative Survival Outcomes of Kidney Transplantation vs. Ongoing Dialysis in Extremely Elderly Patients: A Matched-Pair Study

Comparative Survival Outcomes of Kidney Transplantation vs. Ongoing Dialysis in Extremely Elderly Patients: A Matched-Pair Study

ULTRASOUND DIAGNOSIS OF THE RENAL ARTERY STENOSIS IN A TRANSPLANTED KIDNEY IN THE EARLY POSTOPERATIVE PERIOD

In this clinical case, stenosis of a renal artery of transplant was detected in time by angiography using dynamic Doppler ultrasound control. The chosen treatment method allowed the restoration of arterial patency and thus renal graft function in the shortest possible time and with minimal trauma. However, due to the high risk of restenosis in the plastic area, continuous dynamic ultrasound monitoring and monitoring of the patient's creatinine level are required. The purpose of this presentation is to present a case of early detection of a postoperative complication by Doppler ultrasound, which made it possible to prevent vascular dysfunction, often leading to loss of the renal graft. Materials and Methods. In this article, we report a case of timely detection of renal artery stenosis by ultrasound in a patient, followed by confirmation by angiography and restoration of renal artery and graft function by endovascular balloon angioplasty. All major hemodynamic changes in Doppler ultrasound parameters characteristic of renal artery stenosis are described in this article. Results. Dynamic Doppler ultrasound monitoring and angiography allowed early detection of the described complication of renal transplantation. The optimal choice of treatment tactics allowed the restoration of arterial patency and renal graft function in the shortest possible time, thus preventing graft rejection. Conclusion. Our clinical case demonstrates the importance of the monitor in the assessment of renal perfusion. The outcome of kidney transplantation largely depends on the successful resolution of these issues, which determines the relevance.

Kidney Function and Isolated Kidney Transplant Outcomes in Primary Hyperoxaluria Type 1 Treated with Long-Term Lumasiran

Kidney Function and Isolated Kidney Transplant Outcomes in Primary Hyperoxaluria Type 1 Treated with Long-Term Lumasiran

Association of early steroid withdrawal with kidney transplant outcomes in first-transplant and retransplant recipients.

Early steroid withdrawal (ESW) is often preferred over conventional steroid maintenance (CSM) therapy for kidney transplant recipients with low immunological risks because it may minimize immunosuppression-related adverse events while achieving similar transplant outcomes. However, the risk-benefit balance of ESW could be less favorable in retransplant recipients given their unique immunological risk profile. We hypothesized that the association of ESW with transplant outcomes would differ between first-transplant and retransplant recipients. To assess whether the impact of ESW differs between first and retransplant recipients, we studied 210 086 adult deceased-donor kidney transplant recipients using the Scientific Registry of Transplant Recipients. Recipients who discontinued maintenance steroids before discharge from transplant admission were classified with ESW; all others were classified with CSM. We quantified the association of ESW (vs. CSM) with acute rejection, death-censored graft failure, and death, addressing retransplant as an effect modifier, using logistic/Cox regression with inverse probability weights to control for confounders. In our cohort, 26 248 (12%) were retransplant recipients. ESW was used in 30% of first-transplant and 20% of retransplant recipients. Among first-transplant recipients, ESW was associated with no significant difference in acute rejection (aOR=1.04 [95% CI=1.00-1.09]), slightly higher hazard of graft failure (HR=1.09 [95% CI=1.05-1.12]), and slightly lower mortality (HR=0.93 [95% CI=0.91-0.95]) compared to CSM. Nonetheless, among retransplant recipients, ESW was associated with notably higher risk of acute rejection (OR=1.42 [95% CI=1.29-1.57]; interaction p<0.001) and graft failure (HR=1.24 [95% CI=1.14-1.34]; interaction p=0.003), and similar mortality (HR=1.01 [95% CI=0.94-1.08]; interaction p=0.04). In retransplant recipients, the negative impacts of ESW on transplant outcomes appear to be non-negligible. A more conservatively tailored approach to ESW might be necessary for retransplant recipients.

Clinical profile and outcome of kidney transplantation at Muhimbili National Hospital, Tanzania

BackgroundKidney transplantation is the definitive treatment option for chronic kidney failure, offering improved quality of life and extended survival. Access to kidney transplantation is limited in the Sub-Saharan Africa (SSA) region, with only a few countries with established services. Tanzania started its program five years ago, for the sustainability of the program it is important to understand the outcome. Therefore, this study was conducted to determine the clinical outcomes and survival rates of kidney transplant recipients at Muhimbili National Hospital in Tanzania, in the absence of a national transplant registry, since the inception of the program.MethodsThis was a retrospective study conducted among kidney transplant recipients from live donors at Muhimbili National Hospital (MNH) between November 2017 and February 2022. Analyses were performed to assess baseline characteristics, post-transplant complications, and patient and graft survival.ResultsIn our study of 68 kidney transplant recipients, the majority of recipients were male (63.2%) with a mean age of 45.8 years and under medical insurance (88.2%). The predominant cause of CKD was hypertension (58.2%) with recipients undergoing dialysis for a mean duration of 14.4 months, and basiliximab being the most commonly used induction medication (57.3%). The majority of donors were males (64.7%) and had first-degree relationships with recipients (76.5%). Haploid HLA mismatch was observed in 36.8% of cases. One-year patient and graft survival rates were 91.2% and 96.7%, respectively, with infection being the primary cause of death (n = 5), and more than half of deceased patients died with a functioning graft (n = 4).ConclusionOur study underscores favorable one-year patient and graft outcomes among kidney transplant recipients at Muhimbili National Hospital, Tanzania. However, challenges persist, notably with infections posing ongoing difficulties for this cohort.

Kidney Transplant Outcome Following Donation After Euthanasia.

In the Netherlands, organ donation after euthanasia (donation after circulatory death type V [DCD-V]) has been increasingly performed since 2012. However, the outcomes of DCD-V kidney grafts have not been thoroughly investigated. It is critical to assess the outcomes of these kidney grafts to ascertain whether DCD-V is a safe and valuable way to increase the kidney donor pool. To investigate the outcomes of DCD-V kidney transplantation and compare them with outcomes of kidney transplantation after circulatory death after withdrawal of life-sustaining therapies (DCD type III [DCD-III]) and donation after brain death (DBD). A retrospective cohort study was conducted using the database from the Dutch Transplant Foundation. All kidney transplants in the Netherlands between January 2012 (start of the euthanasia program) and July 2023 were included. Follow-up was obtained through 5 years after transplantation. Data analysis was performed from November 2023 until February 2024. Kidney transplantation with a DCD-V graft compared with DCD-III and DBD grafts. The primary outcome was death-censored graft survival until 5 years after transplantation. Secondary outcomes were the incidence of delayed graft function (DGF), permanent nonfunction (PNF), serum creatinine concentration, and patient survival until 5 years after kidney transplantation. A total of 145 DCD-V kidney transplants were compared with 1936 DCD-III and 1255 DBD kidney transplants. Median (IQR) recipient age was 59 (46-66) years in the DCD-V cohort, compared with 61 (50-68) years in the DCD-III cohort and 61 (50-68) years in the DBD cohort. The incidence of DGF with DCD-V kidney transplants (26%) was significantly less than that with DCD-III kidney transplants (49%; P < .001) and similar to that with DBD kidney transplants (22%; P = .46). PNF occurrence with DCD-V kidneys (6%) was similar to that with DCD-III kidneys (6%; P = .79) and higher than in DBD kidneys (4%; P < .001). There was no difference in 5-year death-censored graft survival between DCD-V grafts (82%) and DCD-III (86%; P = .99) or DBD (84%; P = .99) grafts. There was no difference in 5-year patient survival between DCD-V kidney transplants (69%) and DCD-III (76%; P = .45) or DBD (73%; P = .74) kidney transplants. A propensity score analysis was performed to match the DCD-V and DCD-III cohort, showing results similar to those of the unmatched cohort. This study found that DCD-V kidney transplantation yielded a lower incidence of DGF compared with DCD-III kidney transplantation and yielded long-term results similar to those of DCD-III and DBD kidney transplantation. The findings suggest that DCD-V is a safe and valuable way to increase the kidney donor pool.