Kidney Transplantation Rates Research Articles

The ERA Registry Annual Report 2019: summary and age comparisons.

ABSTRACTBackgroundData on renal replacement therapy (RRT) for end-stage renal disease were collected by the European Renal Association (ERA) Registry via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article provides a summary of the 2019 ERA Registry Annual Report, including data from 34 countries and additional age comparisons.MethodsIndividual patient data for 2019 were provided by 35 registries and aggregated data by 17 registries. Using these data, the incidence and prevalence of RRT, the kidney transplantation activity and the survival probabilities were calculated.ResultsIn 2019, a general population of 680.8 million people was covered by the ERA Registry. Overall, the incidence of RRT was 132 per million population (p.m.p.). Of these patients, 62% were men, 54% were ≥65 years of age and 21% had diabetes mellitus as primary renal disease (PRD), and 84% had haemodialysis (HD), 11% had peritoneal dialysis (PD) and 5% had pre-emptive kidney transplantation as an initial treatment modality. The overall prevalence of RRT on 31 December 2019 was 893 p.m.p., with 58% of patients on HD, 5% on PD and 37% living with a kidney transplant. The overall kidney transplant rate was 35 p.m.p. and 29% of the kidney grafts were from a living donor. The unadjusted 5-year survival probability was 42.3% for patients commencing dialysis, 86.6% for recipients of deceased donor grafts and 94.4% for recipients of living donor grafts in the period 2010–14. When comparing age categories, there were substantial differences in the distribution of PRD, treatment modality and kidney donor type, and in the survival probabilities.

Association of Social Risk Factors With Home Dialysis and Kidney Transplant Rates in Dialysis Facilities

This study examines rates of home dialysis and transplant at dialysis facilities that serve patients with high social risk to understand how they fare under the End-Stage Renal Disease Treatment Choices Model.

Survival Rate of Recipients of Cadaveric-Donor Kidneys in the Transplant unit of Imam Reza Hospital, Tabriz, during the Last Five Years

Background and Objective: Determining the efficiency of kidney transplantation, the survival rate of patients after surgery, and the role of factors affecting this survival is of particular importance. The present study aimed to assess the survival rate of recipients of cadaveric-donor kidneys in the transplant unit of Imam Reza (AS) Hospital in Tabriz during the last five years. Materials and Methods: This descriptive-analytical study was conducted on the recipients of cadaveric-donor kidneys. The data were collected from documents of donor patients, evaluation of blood and urine tests, and follow-up. The required examinations included height, weight, body mass index, age of recipient and donor, blood group, and RH of donor and recipient, donor-recipient kinship, duration of dialysis, year of transplantation, duration of transplantation, duration of patient survival, other drugs (aspirin, heart, hypertension, and cholesterol-lowering medications). Results: In the present study, the survival rates of kidney transplantation at 1, 2, 3, and 5 years were 97%, 90.9%, 79.1%, and 67%, respectively. Moreover, 1, 2, 3, and 5-year survival rates of patients were reported as 98%, 95.5%, 90.9% and 87.4%, respectively. Furthermore, gender and age of kidney donor and recipient were not significantly correlated with renal transplant survival. Conclusion: Kidney transplantation is the most appropriate treatment option for end-stage renal disease patients, leading to better survival and improved quality of life.

Long-Term Outcome of Kidney Transplantation in Children According to Type of Transplantation in Mashhad, Iran:

Background and Aim: Kidney transplantation is the preferred treatment modality for end-stage renal disease (ESRD) in children. Despite its benefits and advances that have been accomplished, pediatric kidney transplantation remains a challenge in terms of achieving a satisfactory outcome. We sought to evaluate the outcome of pediatric kidney transplantation in Mashhad. Methods: Data were acquired retrospectively from children below 18 years old who underwent kidney transplantation in three main hospitals of Mashhad from 2000 to 2014. After obtaining written informed consent from parents, data were collected using a questionnaire and analyzed with the SPSS software. Results: Of 52 children, 51.9% were boys and 48.1% were girls with a mean age of 13.3 ± 4.3 years. Among them, 8 (15.4%) children received transplants from relative live donors, 16 (30.8%) from non-relative live donors, and 28 (53.8%) from deceased donors. The most common etiology leading to ESRD in these children was reflux nephropathy in 18 (34.6%) patients. After a 5-year follow-up period, the graft survival rate was 69.2% with infection being the most common cause of transplant rejection. Moreover, 13.5% of children died, mostly due to surgical complications. Conclusion: We found that to increase the survival rate of pediatric kidney transplantation in Mashhad, first the surgical methods should be enhanced as they were recognized as the most common cause of death. In addition, infection control in children, as the most common cause of transplant rejection, should be improved.

Comparison of 30-day case-fatality rate between dialysis and transplant Covid-19 patients: a propensity score matched cohort study.

Background and objectivesPatients undergoing kidney replacement therapies (KRTs) have a poor prognosis after Covid-19 infection. Few studies have compared the outcomes of such patients in the different KRT modalities. This study aimed to analyze the 30-day Covid-19-associated case-fatality rate of dialysis and kidney transplant patients.MethodsRetrospective cohort study analyzing data from patients with confirmed Covid-19 between Mar/20 and Jan/21 included in two multicenter studies, the Brazilian Covid-19 Dialysis Study (Dialysis group, n = 703) and the Covid-19-KT Brazilian Study (Transplant group, n = 1907). To assess the risk factors for death, adjusted Cox hazards models were used. A sensitivity analysis was performed using a propensity score analysis to match the groups (n = 587 patients in each group).ResultsA higher percentage of transplant patients required hospitalization (68 vs. 51%, p < 0.001), intensive care (37 vs. 30%, p = 0.023), and invasive mechanical ventilation (28 vs. 22%, p = 0.035). Multivariate analysis of the before-matching sample showed that subjects in the transplant group were at a lower death risk at baseline (HR 0.380.560.85). However, they showed higher risk over time (HR 1.031.061.09). Kaplan–Meier analysis after propensity score matching confirmed the inferior 30-day cumulative survival in the transplant recipients (83 vs. 78%, p = 0.0014).ConclusionBoth transplant and dialysis patients have high 30-day case-fatality rates after a Covid-19 diagnosis. Despite lower death risk at baseline, transplant patients have an increased death risk of 6% per day than dialysis patients.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1007/s40620-021-01172-1.

The dialysis facility levels and sizes are associated with outcomes of incident hemodialysis patients

The outcomes of patients with incident kidney failure who start hemodialysis are influenced by several factors. Whether hemodialysis facility characteristics are associated with patient outcomes is unclear. We included adults diagnosed as having kidney failure requiring hemodialysis during January 1, 2001 to December 31, 2013 from the Taiwan National Health Insurance Research Database to perform this retrospective cohort study. The exposures included different sizes and levels of hemodialysis facilities. The outcomes were all-cause mortality, cardiovascular death, infection-related death, hospitalization, and kidney transplantation. During 2001–2013, we identified 74,406 patients and divided them in to three groups according to the facilities where they receive hemodialysis: medical center (n = 8263), non-center hospital (n = 40,008), and clinic (n = 26,135). The multivariable Cox model demonstrated that a larger facility size was associated with a low mortality risk (hazard ratio [HR] 0.991, 95% confidence interval [95% CI] 0.984–0.998; every 20 beds per facility). Compared with medical centers, patients in non-center hospitals and clinics had higher mortality risks (HR 1.13, 95% CI 1.09–1.17 and HR 1.11, 95% CI 1.06–1.15, respectively). Patients in medical centers and non-center hospitals had higher risk of hospitalization (subdistribution HR [SHR] 1.11, 95% CI 1.10–1.12 and SHR 1.22, 95% CI 1.21–1.23, respectively). Patients in medical centers had the highest rate of kidney transplantation among the three groups. In patients with incident kidney failure, a larger hemodialysis facility size was associated with lower mortality. Overall, medical center patients had a lower mortality rate and higher transplantation rate, whereas clinic patients had a lower hospitalization risk.

The Latin American Dialysis and Renal Transplantation Registry: report 2019.

ABSTRACTBackgroundChronic kidney disease (CKD) in Latin America (LA) continues to represent a challenge due to the burden of disease it causes and the difficulty in accessing treatment. LA has a total population of 652 million people living in 20 countries that occupy an area of 19.2 million km2. The Latin American Dialysis and Renal Transplantation Registry (LADRTR), founded in 1991, has collected data and reports on patients receiving kidney replacement therapy (KRT) since 1993. This article summarizes the registry data for 2019.MethodsParticipating countries complete an annual survey collecting aggregated data on incident and prevalent patients on KRT in all modalities. The different treatment modalities considered were hemodialysis (HD), peritoneal dialysis (PD) and living functioning kidney graft (LFG). National gross domestic product per capita (GDP, expressed in US dollars) and life expectancy at birth (LEB) corresponding to the year 2019 were collected from the World Bank Data Bank. Prevalence and incidence were compared with previous years and were also correlated with GDP and LEB.ResultsOn 31 December 2019 a total of 432 610 patients were in KRT in LA, corresponding to an overall unadjusted prevalence of 866 per million population (pmp). Regarding treatment modality, 66.7% of the prevalent patients were treated with HD and 9.3% with PD while 24% of the patients had an LFG. A total of 85 224 patients started KRT in LA, representing a total unadjusted incidence rate of 168 pmp. Diabetic nephropathy as a cause of CKD continues to be a relevant percentage (36%) and five countries reported CKD of nontraditional causes. The kidney transplant rate in the region was 22 pmp, varying from 1 to >60 pmp. The total prevalence of KRT correlated positively with GDP per capita (r2 = 0.6, P < 0.01) and LEB (r2 = 0.23, P < 0.05). The overall incidence rate also significantly correlated with GDP (r2 = 0.307, P < 0.05). The overall unadjusted mortality rate was 13%.ConclusionAccessibility to KRT is still limited in LA. It is necessary to continue the efforts made by each country and the Latin American Society of Nephrology and Hypertension to guarantee equal access to treatment.

Factors Affecting the Long-Term Survival of Kidney Transplantation in Northeastern of Iran between 2000 and 2015.

Background:Graft and patient survival are of great importance after transplantation. This study aimed to determine the long-term survival rate of kidney transplantation and its effective factors among transplanted patients in Mashhad transplantation centers in northeastern Iran.Methods:Overall, 618 kidney transplant recipients were examined in different transplantation centers during the years from 2000 to 2015 in a historical cohort study. The Kaplan-Meier method and the Log-rank test were used to calculate the survival rate of the kidney transplant, and to check the difference between survival curves respectively. Modeling of effective factors in survival rate was performed using Cox regression model.Results:Overall, 1, 3, 5, 7, 10, and 15-year survival rate of kidney transplantation were 99%, 98%, 97%, 93%, 88 and 70% respectively. The adjusted hazard ratio indicated that variables such as recipient age >40 yr [HR=0.22, 95% CI=(0.071,0.691)], serum creatinine after transplantation >1.6 Mg/dl [HR=3.03, 95% CI=(1.284,7.125)], history of hypertension [HR=6.70, 95% CI=(2.746,16.348)], and BMI [HR (normal weight versus underweight)=0.26, 95% CI=(0.088,0.761), HR (over weight versus underweight)=0.13,95% CI=(0.038,0.442)] were significant factors on kidney transplant survival rate.Conclusion:The short-term transplant survival rate was good in transplant patients. What’s more, through a consideration of variables such as age, creatinine serum after transplantation, history hypertension and body mass index, as well as proper planning to control their effect, it is possible to improve the long-term graft survival rate.

Dialysis Outcomes for Children With Lupus Nephritis Compared to Children With Other Forms of Nephritis: A Retrospective Cohort Study

Children with lupus nephritis (LN) are at high risk of developing kidney failure requiring initiation of kidney replacement therapy. This study compared outcomes among children with LN on dialysis with children with non-lupus glomerular disease and investigated risk factors for adverse outcomes among children with LN on dialysis. Retrospective cohort study. Children and adolescents aged 6-20 years with LN (n= 231) and non-lupus glomerular disease (n= 1,726) who initiated maintenance dialysis 1991-2018 and were enrolled in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry. Lupus nephritis. Hospitalization, mortality, and time to transplant. Contingency tables were used to compare hospitalizations, and multivariable cause-specific hazards models were used to compare rates of death and transplantation in children with LN compared with those with non-lupus glomerular disease. Using data from children with LN, multivariable logistic regression models were fit to evaluate the risk factors for hospitalization, and multivariable Cox regression models were fit to evaluate factors associated with kidney transplantation. Children with LN were more likely to be hospitalized in the first year after dialysis initiation (63.3% vs 48.6%, P< 0.001) and were less likely to receive a kidney transplant in the first 3 years after dialysis initiation (year 0-1: adjusted hazard ratio [AHR], 0.36 [95% CI, 0.23-0.57], P< 0.001; year 1-3: AHR, 0.73 [95% CI, 0.54-0.98], P= 0.04). Anemia was associated with hospitalization after dialysis initiation (adjusted OR, 4.44 [95% CI, 1.44-13.66], P= 0.01). Non-White race was associated with a lower rate of kidney transplantation (AHR, 0.47 [95% CI, 0.27-0.82], P= 0.01). LN was not associated with death while on dialysis (AHR, 1.21 [95% CI, 0.47-3.11], P= 0.7). The NAPRTCS registry does not collect information on lupus disease activity or medication doses and has limited data on medication use. Children and adolescents with LN on dialysis are at higher risk for adverse outcomes including hospitalization and lower rates of kidney transplantation compared with children with non-lupus glomerular disease receiving maintenance dialysis.

Simultaneous Pancreas-kidney Transplantation for Type 2 Diabetes Mellitus.

We read with interest the “KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation” published in the April 2020 issue of Transplantation,1 and we congratulate the authors for this important work. However, we are surprised to see the omission of patients with type 2 diabetes mellitus (DM) (often identified by having a normal c-peptide) as potential candidates for simultaneous pancreas-kidney transplantation (SPK) (Recommendation 8.1.1: We suggest candidates with ESKD and type 1 DM be considered for simultaneous pancreas-kidney transplantation in regions where this procedure is available [2A]). Numerous studies in the past decade have shown that carefully chosen SPK recipients with type 2 DM have comparable outcomes including patient and graft survival, reduction in overall morbidity, and improvement in quality-of-life metrics as those with type 1 DM. An analysis of the primary deceased donor pancreas transplants in patients with type 2 DM reported to International Pancreas Transplant Registry/United Network of Organ Sharing between 1995 and 2015 showed that SPK is a safe procedure with excellent pancreas and kidney graft outcome in patients with type 2 DM.2 In addition, in the United States, the Organ Procurement and Transplantation Network policy reflecting careful review of these data does not differentiate between type 1 and type 2 DM patients for SPK candidacy and allows the treatment option for any diabetic patient on insulin.3 Certainly, careful patient selection is paramount. Furthermore, restriction of SPK solely to type 1 DM patients disadvantages African Americans. In the United States, White Americans are more likely to develop type 1 DM, but the prevalence of type 2 DM is 1.4-fold to 2.3-fold higher in African Americans compared with White Americans. African Americans bear a disproportionate burden of the morbidity associated with diabetes, including a higher rate of retinopathy, microalbuminuria, end-stage kidney disease, lower-extremity amputation, and significant mortality. The waiting time for transplant is longer for African Americans than White candidates, and living-donor kidney transplantation rate is lowest for African Americans compared with all other racial groups. SPK allows for both shorter waiting time and often better-quality kidneys as compared with receiving a deceased donor kidney transplant alone, when living-donor kidney transplantation is not an option. Although a major revision to the US pancreas allocation system in 2014 has resulted in a demonstrable increase in pancreas transplant volume, the needs of the diabetic community remain unmet.4 Largely driven by SPK, pancreas transplants in patients with type 2 DM have increased, with comparable results to type 1 DM recipients.5 The proportion of patients with type 2 DM on the waiting list increased to 14.6% in 2018 (Figure 1), with SPK candidates accounting for 74.2% of the list.5 We respectfully request that KDIGO guidelines incorporate current evidence and practice to recommend SPK to medically suitable diabetic patients on insulin regardless of type. This change would be an important step to reduce the inequities in access to transplant benefits to racial minorities with type 2 DM.FIGURE 1.: Distribution of adults waiting for pancreas transplant by diagnosis. Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive candidates are included.5

The Impact of the 2017 Kidney Allocation Policy Change on Simultaneous Liver-Kidney Utilization and Outcomes.

Historically in the United States, kidneys for simultaneous liver-kidney transplantation (SLKT) candidates were allocated with livers, prioritizing SLKT recipients over much of the kidney waiting list. A 2017 change in policy delineated renal function criteria for SLKT and implemented a safety net for kidney-after-liver transplantation. We compared the use and outcomes of SLKT and kidney-after-liver transplant with the 2017 policy. United Network for Organ Sharing Standard Transplant Analysis and Research files were used to identify adults who received liver transplantations (LT) from August 10, 2007 to August 10, 2012; from August 11, 2012 to August 10, 2017; and from August 11, 2017 to June 12, 2019. LT recipients with end-stage renal disease (ESRD) were defined by dialysis requirement or estimated glomerular filtration rate <25. We evaluated outcomes and center-level, regional, and national practice before and after the policy change. Nonparametric cumulative incidence of kidney-after-liver listing and transplant were modeled by era. A total of 6332 patients received SLKTs during the study period; fewer patients with glomerular filtration rate (GFR)≥50 mL/min underwent SLKT over time (5.8%, 4.8%, 3.0%; P= 0.01). There was also less variability in GFR at transplant after policy implementation on center and regional levels. We then evaluated LT-alone (LTA) recipients with ESRD (n=5408 from 2012-2017; n = 2321 after the policy). Listing for a kidney within a year of LT increased from 2.9% before the policy change to 8.8% after the policy change, and the rate of kidney transplantation within 1 year increased from 0.7% to 4% (P<0.001). After the policy change, there was no difference in patient survival rates between SLKT and LTA among patients with ESRD. Implementation of the 2017 SLKT policy change resulted in reduced variability in SLKT recipient kidney function and increased access to deceased donor kidney transplantation for LTA recipients with kidney disease without negatively affecting outcomes.

Does experience matter? The relationship between nephrologist characteristics and end stage kidney disease patient outcomes.

Nephrology offers the unique opportunity to directly link patients to providers, allowing the study of patient outcomes at the provider level. The purpose of this analysis was to determine whether nephrologist experience, defined as years in nephrology practice, was associated with clinical outcomes. Physician data contained within the American Medical Association (AMA) Physician Masterfile was combined with patient and Medicare claims data from the United States Renal Data System (USRDS) for the calendar year 2012, with follow up extending through June 30, 2014. Associations with important healthcare outcomes including mortality in patients receiving maintenance renal replacement therapy (RRT), waitlisting for kidney transplantation, and receipt of a kidney transplant were determined with broad adjustment for both patient and provider level variables, with attention on tertile of provider time in practice. We identified 256,324 patients on maintenance RRT cared for by 6193 nephrologists. Nephrologists with the least experience were more likely to be female, reside in a region with ≥1,000,000 people, have a Doctor of Osteopathic Medicine degree, and have a listed maintenance of certification status as "yes." Overall, 30.2% of the cohort died at a mean follow up of 1.99 years. Compared to those with the 0-10 years of experience, receipt of care from nephrologists with more experience was associated with lower mortality (AHR 0.97 CI 0.94-0.99 for nephrologists with 11-20 years) and increased listing for kidney transplantation (AHR 1.10; CI 1.01-1.21 for nephrologists with >21 years experience). Experience level did not result in a difference in kidney transplantation rates. Receipt of maintenance RRT from nephrologists with greater experience was associated with decreased mortality and increased listing for kidney transplantation, an effect that remained significant after multiple adjustments for important patient and nephrologist variables.

Association of High Burden of End-stage Kidney Disease With Decreased Kidney Transplant Rates With the Updated US Kidney Allocation Policy

The Organ Procurement and Transplantation Network (OPTN) approved changes to the US kidney allocation system in 2019. The potential effects of this policy change using transplant rates normalized to end-stage kidney disease (ESKD) incidence have not been investigated. To estimate how the OPTN kidney allocation policy will affect areas of the US currently demonstrating low rates of kidney transplant, when accounting for the regional burden of ESKD. This cross-sectional population-based economic evaluation analyzed access of patients with ESKD to kidney transplant in the US. Participants included patients with incident ESKD, those on the kidney transplant wait list, and those who received a kidney transplant. Data were collected from January 1 to December 31, 2017, and were analyzed in 2019. The probability of a patient with ESKD being placed on the transplant wait list or receiving a deceased donor kidney transplant. States and donor service areas (DSAs) were compared for gains and losses in rates of transplanted kidneys under the new allocation system. Transplant rates were normalized for ESKD burden. A total of 122 659 patients had incident ESKD in the US in 2017 (58.2% men; mean [SD] age, 62.8 [15.1] years). The probability of a patient with ESKD receiving a deceased donor kidney transplant varied 3-fold across the US (from 6.36% in West Virginia to 18.68% in the District of Columbia). Modeling of the OPTN demonstrates that DSAs from New York (124%), Georgia (65%), and Illinois (56%) are estimated to experience the largest increases in deceased donor kidney allocation. Other than Georgia, these states have kidney transplant rates per incident ESKD cases above the mean (of 50 states plus the District of Columbia, New York is 16th and Illinois is 24th). In contrast, DSAs from Nevada (-74%), Ohio (-67%), and North Carolina (-61%)-each of which has a transplant rate per incident ESKD cases significantly below the mean-are estimated to experience the largest decreases in deceased donor allocation (of 50 states plus the District of Columbia, North Carolina is 34th, Ohio is 38th, and Nevada is 47th). The new OPTN-approved kidney allocation policy may result in worsening geographic disparities in access to transplants when measured against the burden of ESKD within a particular region of the US.

Simultaneous liver kidney allocation policy and the Safety Net: an early examination of utilization and outcomes in the United States.

Rates of simultaneous liver kidney (SLK) transplantation in the United States have progressively risen. On 8/10/17, the Organ Procurement and Transplantation Network implemented a policy defining criteria for SLK, with a "Safety Net" to prioritize kidney allocation to liver recipients with ongoing renal failure. We performed a retrospective review of the United Network for Organ Sharing (UNOS) database to evaluate policy impact on SLK, kidney after liver (KAL) and kidney transplant alone (KTA). Rates and outcomes of SLK and KAL transplants were compared, as was utilization of high-quality kidney allografts with Kidney Donor Profile Indices (KDPI) <35%. Here, SLK transplants comprised 9.0% and 4.5% of total postpolicy liver and kidney transplants compared to 10.2% and 5.5% prior. Policy enactment did not affect 1-year graft or patient survival for SLK and KAL populations. Less postpolicy SLK transplants utilized high-quality kidney allografts; in all transplant settings, outcomes using high-quality grafts remained stable. These findings suggest that policy implementation has reduced kidney allograft use in SLK transplantation, although both SLK and KAL rates have recently increased. Despite decreased high-quality kidney allograft use, SLK and KAL outcomes have remained stable. Additional studies and long-term follow-up will ensure optimal organ access and sharing.

Potential to Mitigate Disparities in Access to Kidney Transplant in the Hispanic/Latino Population With a Specialized Clinic: Single Center Study Representing Single State Data

We sought to evaluate potential disparities in kidney transplant rates in a single state in the United States. We studied the potential to mitigate disparities with a specialized clinic using it as a model presentation. Based on data from the United States Renal Data System and Organ Procurement and Transplantation Network, we estimated the yearly end-stage renal disease and waitlist addition, stratified by race/ethnicity from 2000 to 2018. Institution rates were analyzed similarly, and the implementation of a focused Latino clinic was evaluated. The number of patients added to the national transplant waitlist has increased by 40% in non-Latino whites and by 160% in Latinos from 2000 to 2017. Comparing the period from 2000 to 2004 to 2015 to 2018 in North Carolina, the waitlist increased for Latino patients by 482% and non-Latino whites by 23%. One year after a designated Latino transplant clinic at our institution, there was a 125% increase in the number of Latino referrals for kidney transplant evaluation, a 142% increase in the number of waitlisted Latino patients, and an increase in kidney transplants of 145%. With the increasing number of patients in the Latino community who are diagnosed with end-stage renal disease, there is a direct benefit for a culturally competent program that addresses access to transplants.

Variation in Waitlisting Rates at the Dialysis Facility Level in the Context of Goals for Improving Kidney Health in the United States

Variation in Waitlisting Rates at the Dialysis Facility Level in the Context of Goals for Improving Kidney Health in the United States

Kidney Transplantation during the COVID-19 Pandemic: From Past through Present Time of Emerging Vaccine

The novel coronavirus disease 2019 (COVID-19) pandemic has significantly impacted kidney transplantation worldwide. The rate of kidney transplantation decreased during the peak of the COVID-19 pandemic, especially living donor kidney transplantation. Kidney transplant recipients are at high risk of developing severe complications from COVID-19 due to underlying comorbidities and immunosuppressed status. Management of immunosuppression, including the induction therapy and maintenance immunosuppressive regimen, has been modified at many transplant centers during the pandemic. In severe acute respiratory virus syndrome coronavirus 2 (SARS-CoV-2) infected kidney transplant recipients, the immunosuppression is usually reduced. The acute rejection treatment is usually individualized based on the risks and benefits. Several COVID-19 therapies have received emergency use authorization to prevent the progression of COVID-19 severity. Use of oral antiviral therapies is faced with challenges in terms of drug-drug interaction, drug efficacy, and lack of data in the transplant population. For COVID-19 prophylaxis in kidney transplant recipients, the effectiveness of COVID-19 vaccines is lower compared to the general population. Pre-exposure prophylaxis with a long-acting antibody combination may be an adjunct strategy for vaccination in kidney transplant recipients or those for whom COVID-19 vaccination is not contraindicated. Post-exposure prophylaxis remains to be studied. Further studies are necessary to establish standard guidelines of immunosuppressive management in kidney transplant recipients diagnosed with COVID-19 and to better understand the outcomes and adverse drug reactions of the therapeutic and prophylactic modalities including vaccination in this high-risk population.

Long-Term Outcome of Kidney Transplant Among Iranian Children: A Systematic Review and Meta-Analysis.

End-stage kidney disease has dramatic health effects and life consequences in children. Presently, kidney transplant has been globally accepted as a treatment of choice for end-stage kidney disease in both children and adults, leading to better quality of life and longer patient survival. Because of lack of comprehensive information on the outcome of kidney transplant among children in Iran, we aimed to present a proper vision of pediatric kidney transplant in Iran by systematically reviewing the current literature. Major databases were searched, including Medline, Web of Knowledge, Google Scholar, Scopus, Cochrane, and the Iranian Scientific Information Database for all eligible studies in accordance with specific keywords. The inclusion criteria forthe retrieved studies were determination of graft survival, patient survival, and reasons for graft failure. The exclusion criteria were as follows: (1) a lack of clearresults; (2) non-English or non-Persian language format; (3) lack of access to the full-text manuscripts; and (4) case reports, case series, and review papers. A total of 115 studies were initially assessed based on the keywords; of these, 8 met inclusion criteria and were considered for final analysis; these were published between 2005 and 2017. According to our results, 1-year graft survival rates were overall 89.7%, and 5-year graft survival rates were 65.4%. The 1-year patient survival rates were estimated to be 97.1%, and 5-year patient survival rates were estimated to be 89.8%. Acute rejection, dialysis status before transplant, and inappropriate immunosuppression were the main risk factors. Our systematic review and meta-analysis indicated a high success rate of childhood kidney transplant in Iran according to long-term graft and patient survival rates.

Paediatric kidney transplantation in under-resourced regions-a panoramic view.

Kidney transplantation is the ideal choice of kidney replacement therapy in children as it offers a low risk of mortality and a better quality of life. A wide variance in the access to kidney replacement therapies exists across the world with only 21% of low- and low-middle income countries (LLMIC) undertaking kidney transplantation. Pediatric kidney transplantation rates in these under-resourced regions are reported to be as low as < 4 pmcp [per million child population]. A robust kidney failure care program forms the cornerstone of a transplant program. Even the smallest transplant program entails a multidisciplinary workforce and expertise besides ensuring family commitment towards long-term care and economic burden. In general, the short-term graft survival rates from under-resourced regions are comparable to most high-income countries (HIC) and the challenge lies in the long-term outcomes. This review focuses on specific issues relevant to kidney transplants in children in under-resourced regions by highlighting limitations in the capacity and health workforce, regulatory norms, medical issues, economic burden, factors beyond financial hardship and ethical considerations relevant to these regions. Finally, the perspective of strengthening transplant programs in these regions should factor in the bigger challenges that exist in achieving the health-related sustainable development goals by 2030.

POS-701 OVER TEN-YEARS KIDNEY GRAFT SURVIVAL DETERMINANTS : A SINGLE CENTER EXPERIENCE

Renal transplantation is the treatment of choice for patients with end-stage kidney disease, offering cost, quality of life, and survival benefits over the alternative of dialysis. Over the past few decades surgical and medical advances have led to continuous improvement in short term graft survival, but this progress has not been accompanied by similar improvements in long-term graft survival and kidney transplant recipients continue to experience late allograft failure. The aim of this study was to estimate long-term survival rate of kidney transplantation and to detect associated prognostic factors. This is a retrospective study included adults who underwent kidney transplantation between 1995 and 2008 in the nephrology department of the Fattouma Bourguiba Hospital in Monastir (Tunisia). They were followed until 31 December 2018.Therefore, this cohort was followed for at least 10 years. Data were collected from patients’ medical records using a checklist. We compared the demographic, clinical, immunological, and laboratory profile of patients who had functional grafts ≥ 10 years after kidney transplantation to those whose transplants survived <10 years. Kaplan-Meier curve, log-rank test was used to compare survival curves and Cox proportional hazard model were used to multivariate analysis. The study cohort included 59 patients with a mean age of 30,83±10,14 years with M:F ratio of 1.68. The mean graft survival was 11.22±4,14 years in the overall cohort. The graft survival rates at 1 ,3, 5, 7 and 10 years were 98,3%,93,2%,89,8%,81,4%and 59,3% respectively. We identified 45 (76 ,3%) patients with a functional graft for 10 or more years after transplantation and 18.6% for 15 or more. In the univariate analyses factors statistically associated to long survival (≥ 10-year) were: recipient age below 35 years (P = 0.016), ABO-identical matching (P = 0.02), higher 3 month (P = 0.01) , one-year (P = 0.01), 5 years (P = 0.02) estimated glomerular filtration rate and no CMV infection after transplantation (P = 0.01). Our experience in renal transplantation survival rates indicate a success rate comparable to those noted in other reports. The renal function at 1-year after transplantation is important for the 10-year survival of kidney transplants. Accordingly, efforts should be targeted to preserving graft function in the first year after kidney transplantation.