Survival Benefit Of Transplantation Research Articles

Waitlist Time, Age, and Social Vulnerability: Impact on the Survival Benefit of Deceased Donor Kidney Transplantation Versus Long-term Dialysis Among Patients With End-stage Renal Disease.

We sought to define the survival benefit of kidney transplantation versus long-term dialysis relative to waitlist time on dialysis, social vulnerability, and age among end-stage renal transplant candidates. End-stage renal disease patients who were candidates for their first deceased donor kidney transplantation between 2008 and 2020 were identified using the US Renal Data System. Survival probabilities for patient survival were compared using the restricted mean survival times (RMSTs) across different age and social vulnerability index (SVI) ranges. Among 149 923 patients, 68 795 (45.9%) patients underwent a kidney transplant and 81 128 (54.1%) remained on dialysis. After propensity-score matching (n = 58 035 in each cohort), the 5-y RMST difference between kidney transplant and dialysis demonstrated an increasing trend in mean life-years gained within 5 y of follow-up relative to advancing age (<30 y: 0.40 y, 95% confidence interval, 0.36-0.44 y versus >70 y: 0.75 y, 95% confidence interval, 0.70-0.80 y). Conversely, disparities in 5-y RMSTs remained consistent relative to social vulnerability (median 5-y RMST difference: 0.62 y comparing low versus high SVI). When considering waitlist duration, stratified analyses demonstrated increasing trends across different age groups with the largest RMST differences observed among older patients aged ≥70 y. Notably, longer waitlist durations (>3 y) yielded more pronounced RMST differences compared with shorter durations (<1 y). These data underscore the survival benefit associated with kidney transplantation over long-term dialysis across various age and SVI ranges. Transplantation demonstrated a greater advantage among older patients who had a longer waitlist duration.

Survival benefit of autologous transplant (ASCT) for mantle cell lymphoma (MCL) in the California Cancer Registry (CCR).

e19043 Background: Extended follow up of the prospective Nordic MCL2 cohort shows ASCT in CR1 confers a median OS (mOS) of 12.7 y (Eskelund, BJH 2016). Incorporation of BTK inhibitors in 1L MCL is challenging the role of ASCT in an ongoing prospective trial (TRIANGLE, ASH 2022). The present study aims to evaluate the role of ASCT and the impact of social determinants of health (SDH) in a diverse real-world population of MCL patients. Methods: Adult MCL patients diagnosed from January 1, 2000 to December 31, 2020 in the CCR were identified with ICD-O-3 code 9673. The study was approved by UCLA IRB. OS was estimated using KM statistics, calculated from diagnosis to death/last follow-up. Univariate Cox proportional hazards modeling for lymphoma-specific survival (LSS) was performed for variables of interest; those significant at p ≤ 0.10 were incorporated in a stepwise multivariable regression excluding patients with missing data. Socioeconomic status (SES) variables were reported using census-block group data at diagnosis. Results: 5740 ethnically diverse patients were included (NH Whites, n=4038; NH Black, n=175; Hispanic, n=1057; Asian/Pacific Islanders, n=400). Median age at diagnosis was 69 y (IQR 61–68) and 71% were males. 4096 (71%) and 1346 (23%) patients received chemoimmunotherapy and were treated at an NCI/NCCN center, respectively. With a median follow-up of 33 m (IQR 9–76), mOS of the entire cohort was 4.4 y. ASCT patients (n=652, 11%) had improved mOS compared to non-ASCT (14.2 y vs 3.7 y, respectively p&lt;0.001), and 100-day TRM was 2.5%. In the univariable model for all subjects, age, Charlson Comorbidity Index (CCI), married, chemoimmunotherapy, ASCT, NCI/NCCN center, insurance, period of diagnosis, and community SES, poverty, and education were prognostic for LSS. Race, sex, and rural residence were not associated with LSS. Multivariable analysis of 4148 subjects showed significant predictors of LSS were age ≥ 70 y (HR 1.71, p&lt;0.001), ASCT (HR 0.54, p&lt;0.001), diagnosis after 2013 (HR 0.78, p&lt;0.001), CCI (Ref 0; 1-2 HR 1.22, p&lt;0.001; 3+ HR 1.94, p&lt;0.001), married (HR 0.86, p=0.003), NCI/NCCN treatment center (HR 0.77, p=0.001), higher education (top 40% with high school diploma vs. bottom 20%, HR 0.70, p&lt;0.001), higher overall SES (medium vs. low SES tertile, HR 0.81, p=0.003), and increased community poverty (middle 40% vs. bottom 20%, HR 1.14, p=0.043). Conclusions: Our data represent the largest real-world cohort describing the role of ASCT and SDH in MCL. A minority of patients received ASCT and had improved OS compared to non-ASCT patients. While follow-up of ongoing prospective studies will clarify the role of ASCT using contemporary 1L regimens, the present data suggest ASCT in select patients results in durable response with low TRM. Socially disadvantaged patients should be identified and offered supportive programs early in the disease course to mitigate inferior outcomes.

#543 Cognitive improvement in end stage renal disease patients post transplantation—a prospective observational study

Abstract Background and Aims Global life expectancy at birth has increased from 66.8 years in 2000 to 73 years in 2019, as per data given by WHO in 2020. With the aging of the population, chronic kidney disease has become one of the common non communicable diseases in the world as well as one of the leading causes of mortality. Cognitive impairment begins early during chronic kidney disease and parallels kidney function decline. Cognitive dysfunction may affect the patient's daily functioning, employment options, medical adherence, medical decision making and is an independent predictor of mortality. Kidney transplantation can correct the metabolic derangements and eliminate the fluid and osmotic shifts that patients can experience on dialysis. However, cognitive impairments still persist post transplant and diagnosing and managing cognitive impairment is critical. Although there is a well established survival benefit of renal transplantation, the evidence of its effect on cognitive function is limited and not entirely consistent. Additional clinically relevant questions include whether existing comorbid conditions and associated endothelial dysfunction result in cognitive impairment that is not reversible with kidney transplant and which domains of cognition improve after transplant. This study aims to determine the proportion of patients showing cognitive improvement 3 months and 6 months post renal transplantation using Montreal Cognitive Assessment and to find the cognitive domains which show improvement post renal transplantation. This study also focusses on various parameters post transplant which may have affect the cognition of kidney transplant recipients. Method This study is a prospective observational study, conducted in a total of 100 patients, age group between 18 to 60 years who underwent renal transplantation in Medanta Hospital, India. Patients were enrolled in the study after taking informed consent. Patient demographics including age, sex, basic disease, co morbidities, dialysis vintage were recorded. Montreal cognitive assessment score was recorded during pre transplant period and was again recorded at 3 months and at 6 months posttransplant during outpatient department visits. Any episodes of infection, rejection or graft loss were recorded up to a period of 6 months post transplantation. Results with Figures 26 patients out of 100 showed improvement in Montreal Cognitive assessment score three months post renal transplantation and 56 patients out of 100 showed improvement in Montreal Cognitive assessment score 6 months post transplantation, when compared to their score at pre transplant level. The Mean Montreal cognitive assessment score at pre transplant level was 24.08 ± 3.08, at 3 months post-transplant was 24.32 ± 2.90 and at 6 months post-transplant was 25.28 ± 3.05. The difference between the mean score at 3 months post transplant when compared to mean score at pre transplant level was not found to be statistically significant p value 0.07. The difference between the mean score at 6 months post transplant when compared to the mean score at pre transplant level was found to be statistically significant p value &amp;lt;0.001. Among the various cognitive domains tested, delayed recall showed significant improvement after 3 months and 6 months post transplant with p values of 0.016 and &amp;lt; 0.001 respectively. Conclusion Significant cognitive improvement was seen 6 months post renal transplant. Delayed recall showed significant improvement after 3 and 6 months post renal transplant. This study concluded that patients who showed improvement in cognition 6 months post transplant did not show any significant correlation between the parameters studied such as serum sodium, calcium, haemoglobin, creatinine, age, rates of rejection and infection or use of any specific induction agent and improvement in Montreal cognitive assessment score. The screening for cognitive functions after kidney transplantation is not yet a routine practice and must be included in the routine follow up of the kidney transplant recipients.

(546) - Association of the 2018 US Heart Allocation Policy Change and the Survival Benefit of Heart Transplantation

(546) - Association of the 2018 US Heart Allocation Policy Change and the Survival Benefit of Heart Transplantation

Efficacy and Safety of Chidamide Combined with BEAM Conditioning Regimen in Autologous Transplantation for T-Cell Lymphoma

Background: T cell lymphoma (TCL) is a group of highly heterogeneous aggressive non-Hodgkin lymphomas with different pathogenesis and clinical prognosis. Despite the survival benefits of anthracycline-based chemotherapy bridging autologous stem cell transplantation (ASCT), 40% to 50% of TCL patients fail to respond to treatment and relapse or die within a short period of time. Chidamide is an oral selective histone deacetylase inhibitor (HDACi), interferes with epigenetic regulation by deacetylating nuclear transcription factors, affects proliferation and differentiation of tumor cells, and regulates cytokines in the tumor microenvironment. Chidamide combined with chemotherapy has promising clinical applications in ASCT. Aims: This prospective Phase II trial aims to evaluate the efficacy and safety of chidamide in combination with carmustine, etoposide, cytarabine, and melphalan (Chi-BEAM) conditioning regimen in ASCT of TCL patients received CR/PR to first-line chemotherapy. Method: In this study, eligible patients with TCL (except IPI 0-1 ALK+ anaplastic large cell lymphoma) aged 18-65 years were enrolled. All patients received Chi-BEAM conditioning regimen before ASCT. 30mg of chidamide was administered twice a week for at least 2 years after ASCT.The primary end point was 2-year progression-free survival (PFS) rate, and the secondary end points were 2-year overall survival (OS) rate and safety evaluation. Results: At the time of data cut off, a total of 18 patients were enrolled, with a median age of 48 (15-65) years. The 1-year PFS rate and OS rate after ASCT were 90.0% and 100.0%, respectively. The median implantation time of neutrophils was 10 days (9-13 days), and the median implantation time of platelets was 17 days (11-25 days). Most of the adverse reactions (AEs) were tolerable, including controlled grain deficiency with fever, electrolyte disturbance, and abnormal liver function. Conclusion: Chidamide combined with BEAM as a conditioning regimen for ASCT can significantly improve PFS and OS in TCL patients, and the AEs are controllable. The study is ongoing and further results will be continuously released.

Intention-to-treat analysis for survival benefit of ABO-incompatible living-donor liver transplantation in patients with a high Model for End-stage Liver Disease score

Intention-to-treat analysis for survival benefit of ABO-incompatible living-donor liver transplantation in patients with a high Model for End-stage Liver Disease score

Survival benefit of kidney transplantation in patients with end-stage kidney disease and prior acute myocardial infarction

Survival benefit of kidney transplantation in patients with end-stage kidney disease and prior acute myocardial infarction

313.3: Long-Term survival and life-time benefit of pancreas transplantation

313.3: Long-Term survival and life-time benefit of pancreas transplantation

Autologous hematopoietic stem cell transplantation improves survival outcomes in peripheral T-cell lymphomas: a multicenter retrospective real-world study

The aim of this study is to evaluate the survival benefit of consolidative autologous hematopoietic stem cell transplantation (ASCT) in patients with peripheral T-cell lymphomas (PTCL). In this retrospective study, the ASCT group underwent consolidative ASCT after first-line therapy at 14 transplantation centers in China between January 2001 and December 2019. Data were collected over the same time frame for the non-ASCT group from the database of lymphoma patient records at Peking University Cancer Hospital & Institute. A total of 120 and 317 patients were enrolled in the ASCT and non-ASCT groups, respectively, and their median ages were 43 years and 51 years, respectively. In the ASCT group, 101 patients had achieved complete remission (CR) and 19 patients had achieved partial remission at the time of ASCT. The median follow-up time was 40.2 months and 68 months, and the 3-year overall survival (OS) rate was 80.6% and 48.9% (p < 0.001) for the ASCT and non-ASCT groups, respectively. The beneficial effect of ASCT for OS remained even after propensity score-matched (PSM) analysis (81.6% vs 68.3%, p = 0.001). Among the 203 patients who were aged ≤ 65 years and achieved CR, ASCT conferred a significant survival benefit (3-year progression-free survival [PFS]: 67.4% vs 47.0%, p = 0.004; 3-year OS: 84.0% vs 74.1%, p = 0.010), and this was also maintained after PSM analysis (3-year PFS: 66.6% vs 48.4%, p = 0.042; 3-year OS: 84.8% vs 70.5%, p = 0.011). Consolidative ASCT improved the survival outcome of PTCL patients, even those who achieved CR after first-line therapy.

Survival Benefit of Kidney Transplantation in Patients With End-Stage Kidney Disease and Prior Acute Myocardial Infarction.

Patients with end stage kidney disease (ESKD) and a previous acute myocardial infarction (AMI) have less access to KT. Data on ESKD patients with an AMI history who underwent first KT or dialysis between January 2007 and December 2018 were extracted from the Korean National Health Insurance Service. Patients who underwent KT (n = 423) were chronologically matched in a 1:3 ratio with those maintained on dialysis (n = 1,269) at the corresponding dates, based on time-conditional propensity scores. The 1, 5, and 10years cumulative incidences for all-cause mortality were 12.6%, 39.1%, and 60.1% in the dialysis group and 3.1%, 7.2%, and 14.5% in the KT group. Adjusted hazard ratios (HRs) of KT versus dialysis were 0.17 (95% confidence interval [CI], 0.12-0.24; p < 0.001) for mortality and 0.38 (95% CI, 0.23-0.51; p < 0.001) for major adverse cardiovascular events (MACE). Of the MACE components, KT was most protective against cardiovascular death (HR, 0.23; 95% CI, 0.12-0.42; p < 0.001). Protective effects of KT for all-cause mortality and MACE were consistent across various subgroups, including patients at higher risk (e.g., age >65years, recent AMI [<6months], congestive heart failure). KT is associated with lower all-cause mortality and MACE than maintenance dialysis patients with a prior AMI.

SP5.12 Pancreas Graft Outcome dictates the Renal Graft outcomes and overall patient survival in Simultaneous Kidney Pancreas (SPK) Transplant recipients. A UNOS/OPTN Transplant Registry Big Data Analysis over the last 20 years. An Epidemiology In Transplant Study Group (ETrSG) Initiative

Abstract Purpose Pancreatic graft outcomes affect the cumulative outcomes of SPK transplant, yet the impact of pancreas graft loss on renal graft and overall patient survival is yet to be reported. Methods We harmonized the UNOS/OPTN SPK Transplant data (1996-2019) reported to the U.S. Dept. of Health and Human Services to analyze survival outcomes of recipients who had all cause pancreas graft loss. The demographics report and survival analysis (renal graft/ patient survival) at 1,3, and 5 years post-transplant were data mined. Logistic Regression was done to identify predictors of survival. Results N=7036 all-cause pancreatic graft losses were reported from a cohort of N=64815 SPK Transplant recipients during the first five years of transplant. The renal graft survival was 99%, 97%, and 95% in functioning SPK transplant; 77%, 68%, and 54% in recipients with pancreatic graft loss at 1,3, and 5 years respectively. (Log-rank &amp;lt;0.001). The overall patient survival was 84%, 75%, and 66% in recipients with pancreatic graft loss at 1,3, and 5 years, respectively (Log-rank &amp;lt;0.001). Recipient age &amp;gt;45 years (p=0.008), recipient smoking history ( p&amp;lt;0.001), recipient history of hypertension ( p&amp;lt; 0.001), Recipient BMI &amp;gt;30 (p=0.01), cardiac events ( p=0.02) were the variables of importance on univariate analysis affecting renal graft and patient survival. Recipients with functioning Pancreas had a renal transplant survival benefit (0.22; 0.45) at 1 and 5 years &amp; overall patient survival (0.15; 0.33) at 1 and 5 years respectively. Conclusions Functioning pancreas graft confers survival benefit to renal graft and overall patient survival. The survival deteriorates over time since pancreas graft failure.

Survival benefit of living-donor liver transplantation in patients with a model for end-stage liver disease over 30 in a region with severe organ shortage: a retrospective cohort study.

The benefits of living-donor liver transplantation (LDLT) in patients with a high Model for End-stage Liver Disease (MELD) score (who have high waitlist mortality) are unclear. Regional availability of deceased-donor organs must be considered when evaluating LDLT benefits. The authors aimed to compare the survival benefit of intended-LDLT to awaiting deceased-donor liver transplantation (DDLT) in patients with a MELD score greater than or equal to 30 in a region with severe organ shortage. This retrospective review included 649 patients with a MELD score greater than or equal to 30 placed on the liver transplantation waitlist. They were divided into intended-LDLT ( n =205) or waiting-DDLT ( n =444) groups based on living-donor eligibility and compared for patient survival from the time of waitlisting. Post-transplantation outcomes of transplant recipients and living donors were analyzed. Intended-LDLT patients had higher 1-year survival than waiting-DDLT patients (53.7 vs. 28.8%, P <0.001). LDLT was independently associated with lower mortality [hazard ratio (HR), 0.62; 95% CI, 0.48-0.79; P <0.001]. During follow-up, 25 patients were de-listed, 120 underwent LDLT, 170 underwent DDLT, and 334 remained on the waitlist. Among patients undergoing transplantation, the risk of post-transplantation mortality was similar for LDLT and DDLT after adjusting for pretransplantation MELD score (HR, 1.86; 95% CI, 0.73-4.75; P =0.193), despite increased surgical complications after LDLT (33.1 vs. 19.4%, P =0.013). There was no mortality among living-donors, but 4.2% experienced complications of grade 3 or higher. Compared to awaiting DDLT, LDLT offers survival benefits for patients with a MELD score greater than or equal to 30, while maintaining acceptable donor outcomes. LDLT is a feasible treatment for patients with a MELD score greater than or equal to 30 in regions with severe organ shortages.

Survival Benefit of Solid-Organ Transplantation: 10-Year Update.

Transplantation has transformed into a burgeoning field that is rapidly evolving to optimize organ distribution and survival outcomes. The years since 2012 (the last comprehensive study) have seen changes in transplantation, such as advances in immunotherapy and novel indices, that necessitate an updated analysis of survival benefit. Our goal was to determine the survival benefit for solid-organ transplants in the United Network for Organ Sharing (UNOS) database for a three decade period and provide updates on advancements since 2012. Our retrospective analysis examined data containing U.S. patient records from September 1, 1987, to September 1, 2021. We found that 3,430,272 life-years were saved over our transplant period (4.33 life-years saved per patient); kidney-1,998,492 life-years; liver -767,414; heart-435,312; lung-116,625; pancreas-kidney-123,463; pancreas-30,575; intestine-7901. After matching, 3,296,851 life-years were saved. Life-years saved and median survival increased for all organs between 2012 and 2021. Compared to 2012, median survival increased in kidney (from 12.4 to 14.76years), liver (from 11.6 to 14.59), heart (9.5 to 11.73), lung (5.2 to 5.63), pancreas-kidney (from 14.5 to 16.88), pancreas (from 13.3 to 16.10). When compared to 2012, the percent transplanted increased in kidney, liver, heart, lung, and intestine, while pancreas-kidney and pancreas show decreased percent transplanted. Our study underscores the tremendous survival benefits of solid organ transplantation (over 3.4 million life-years saved) and shows improvements since 2012. Our study also highlights areas of transplantation, notably pancreas transplants, that may necessitate reinvigorated attention.

Sex differences in the survival benefit of kidney transplantation: a retrospective cohort study using target trial emulation.

Kidney transplantation is the preferred treatment for eligible patients with kidney failure who need renal replacement therapy. However, it remains unclear whether the anticipated survival benefit from kidney transplantation is different for women and men. We included all dialysis patients recorded in the Austrian Dialysis and Transplant Registry who were waitlisted for their first kidney transplant between 2000 and 2018. In order to estimate the causal effect of kidney transplantation on 10-year restricted mean survival time, we mimicked a series of controlled clinical trials and applied inverse probability of treatment and censoring weighted sequential Cox models. This study included 4408 patients (33% female) with a mean age of 52 years. Glomerulonephritis was the most common primary renal disease both in women (27%) and men (28%). Kidney transplantation led to a gain of 2.22 years (95% CI 1.88 to 2.49) compared with dialysis over a 10-year follow-up. The effect was smaller in women (1.95 years, 95% CI 1.38 to 2.41) than in men (2.35 years, 95% CI 1.92 to 2.70) due to a better survival on dialysis. Across ages the survival benefit of transplantation over a follow-up of 10 years was smaller in younger women and men and increased with age, showing a peak for both women and men aged about 60 years. There were few differences in survival benefit by transplantation between females and males. Females had better survival than males on the waitlist receiving dialysis and similar survival to males after transplantation.

Prior cancer history and suitability for kidney transplantation.

Kidney transplantation is the optimal treatment for most patients with kidney failure. For patients with a prior history of treated cancers, listing and transplant eligibility decisions are complex. Patients and health professionals are obliged to consider the time-periods between cancer cure and transplantation, the risk of cancer recurrence under the influence of immunosuppression and anti-cancer treatment options if the disease recurs. Cancer recurrence is associated with a high mortality rate, thus potentially reduces the projected survival benefit of transplantation, and dampens the utility of scarce organs. In view of the uncertain risk of harms, clinicians may consider transplantation for candidates with prior cancer history only after an extended period of cancer-free interval, as the fear of disease recurrence and shortened life expectancy may outweigh the benefits of receiving a kidney transplant compared with dialysis. Over the past decade, the evolution of novel anti-cancer therapies coupled with improved understanding of cancer genomics have led to considerable improvement in cancer-free survival. It is therefore justifiable to make individualized transplant suitability decisions based the joint effects of cancer biology, available therapeutic options and prognostic covariates on clinical outcomes. In this review, we first summarized the cancer epidemiology in kidney transplant recipients. We then explored how the probability of cancer cure, risk of recurrence and outcomes in candidates with a prior cancer history may influence the decisions to transplant. Finally, the role of shared decision-making between health professionals and patients regarding the optimal management options, and considerations of patients' preferences and values are discussed.

#5733 NIERKEUZE.NL: A WEB-BASED APPLICATION TO SUPPORT THE SHARED DECISION PROCESS FOR KIDNEY REPLACEMENT THERAPY BASED ON OUTCOME DATA IN THE NETHERLANDS

Abstract Background and Aims Access to individualized, evidence-based prognostics is needed to facilitate shared decision making about the clinical implications of whether to opt for kidney transplantation or long-term dialysis. We aim to implement a data-driven support tool (Nierkeuze.nl) that incorporates basic patient characteristics and treatment options. Method Consecutive patients (N = 14.275) above 18 years of age with end-stage-renal-disease (ESRD) who were eligible candidates for their first kidney transplantation and started renal replacement therapy between 2000 and 2019 were included from the national registries RENINE and NOTR. SF-12 quality of life data was obtained from RENINE and a local transplant database. Several algorithms were developed to predict waiting time, short- and long-term patient survival, graft survival, and quality of life according to factors that are known at ESRD. Probabilities of 3- and 5-year mortality were calculated using two-stage distinct Cox regression: 1) waitlist-mortality according to median time on the waiting list, 2) mortality after transplantation in remaining follow-up. Product and complement rules defined the final probabilities. No mortality on the waiting list was assumed for living donor transplants. Missing data were imputed. Model performance was evaluated by internally validated C-statistics and calibration plots. Results We included 4.889 deceased donor transplants, of which 990 were within the Eurotransplant Senior allocation Program (ESP), and 6.251 living donor transplants. Discrimination varied for patient survival models (C-stats: 0.68 deceased-ETKAS-TX; 0.58 for deceased-ESP-TX; 0.74 for living-TX; 0.64 for waitlisted-candidates). Survival models achieved good calibration by visual inspection across the range of predicted probabilities. Figure 1 illustrates a clear 5-year survival benefit of transplantation (living and deceased donor groups) compared with wait-listed candidates for a 65-year-old male with glomerulonephritis. Other developed algorithms of the support tool will be presented with an overview of the first experiences in the kidney failure clinic. Conclusion Nierkeuze.nl depicts the influence of anticipated waiting time, patient characteristics, kidney allocation program, and donor type on survival outcome of the different treatment options. Incorporating this individualized quantitative outcome information may provide valuable support for an informed choice by patients and potential living donors.

A review of elderly transplantation regarding complications, outcomes, and survival

BackgroundRenal transplant adds survival benefits to end-stage renal disease patients over dialysis, and a similar concept applies to elderly patients. Some of the challenges of transplanting old patients may involve age-related cancers and comorbid conditions such as cardiovascular disease. Studies had shown that advanced age is associated with better outcomes compared to dialysis despite receiving poorer quality organs. AimThis extended literature review aims to identify the common complications, outcomes, and survival benefits of kidney transplantation in the elderly population. MethodsAn extended literature review was done to identify studies that compared elderly transplant recipients with the younger kidney transplant recipient population. The study population included elderly kidney recipients aged sixty and above and younger kidney recipients below the age of sixty. This literature review aims to discuss complications facing elderly kidney recipients and compare transplant outcomes to younger kidney recipients. PubMed, Midline, and google scholar databases were searched and papers meeting the pre-set inclusion criteria were identified. ResultsA total of 212 papers were identified. After screening the results, 12 papers met the inclusion criteria and were included for review. 10/12 papers included patients' age cutoff point, one paper had cut-off age between 60 and 80 years, while the last paper recruited patients with ages above 70. Most of the studies mentioned young group age as below 60, 2/12 papers divided the young group into further subgroups of age. Two studies used paired donor organs for both young and elderly groups to eliminate donor bias. While other studies used living, deceased, or both living and deceased donors for both elderly and young groups. One study matched donor type and gender in both groups. The studies looked at patient and graft survival and complications. Elderly transplant patients suffered more hospitalization, infections, cardiovascular complications, malignancy, and surgical complications. Post-transplant diabetes was higher in the young recipient group in one study. ConclusionIn the case of elderly renal transplant recipients, the cut-off point for age to perform renal transplant is not clear but studies showed better survival and cost-effectiveness in elderly patients compared to patients on the waiting list even in older patient cohorts

Expanding the heart donor pool: Can left ventricular assist devices substitute for marginal donor heart allografts?

BackgroundGenerally, heart transplantation with marginal donor allografts is reserved for a subset of high-risk patients. However, given the improved survival rates for patients on left ventricular assist devices, it is worth analyzing if they could potentially substitute for marginal donor allografts. This study aimed to compare survival outcomes of waitlisted patients with left ventricular assist devices who did not undergo heart transplantation to those who underwent heart transplantation with marginal allografts. MethodsThis was a retrospective cohort study of adults (≥18 years) listed for heart transplantation between 2010 and 2022 in the Organ Procurement and Transplantation Network database. A previously validated risk score was used to define marginal donor organs. The primary outcome was death after transplantation or on the waitlist, as appropriate. ResultsOf 5,713 patients with left ventricular assist devices, 4,683 (82%) comprised the left ventricular assist devices group and 1,030 (18%) the marginal group. The marginal cohort was older (57 [49–64] vs 55 [45–62] years, P < .001), similarly female (26 vs 24%, P = .16), and less often White (51 vs 60%, P < .001). Relative to the left ventricular assist devices group, the marginal group demonstrated higher 5-year survival from 2010 to 2014 (81 vs 43%, P < .001) and from 2015 to 2019 (77 vs 66%, P < .001). After adjustment, marginal patients demonstrated a significantly reduced hazard of 5-year mortality for those listed from 2010 to 2014 (hazard ratio 0.25, confidence interval 0.20–0.31; P < .001) and from 2015 to 2019 (hazard ratio 0.46, confidence interval 0.37–0.57; P < .001). ConclusionOur study validates the superiority of transplantation relative to left ventricular assist devices but also underscores the survival benefit of heart transplantation with marginal donor allografts, even in high-risk patients.

Stratified Analysis of Survival Benefit for ABO-incompatible Deceased-donor Liver Transplantation: Multicenter Propensity Score-matched Study.

Liver transplantation (LT) using ABO-incompatible (ABOi) grafts can extend the donor pool to a certain extent and hence reduce the waiting time for transplantation. However, concerns of the impending prognosis associated with this option, especially for patients with liver failure and higher model for end-stage liver disease (MELD) scores, who tend to be more fragile during the waiting period before LT. Recipients undergoing LT for acute-on-chronic liver failure or acute liver failure were retrospectively enrolled at four institutions. Overall survival was compared and a Cox regression analysis was performed. Propensity score matching was performed for further comparison. Patients were stratified by MELD score and cold ischemia time (CIT) to determine the subgroups with survival benefits. Two hundred ten recipients who underwent ABOi LT and 1,829 who underwent ABO compatible (ABOc) LT were enrolled. The 5-year overall survival rate was significantly inferior in the ABOi group compared with the ABOc group after matching (50.6% vs. 75.7%, p<0.05). For patients with MELD scores ≤30, using ABOi grafts achieved a comparable overall survival rate as using ABOc grafts (p>0.05). Comparison of the survival rates revealed no statistically significant difference for patients with MELD scores ≥40 (p>0.05). For patients with MELD scores of 31-39, the overall survival rate was significantly inferior in the ABOi group compared with the ABOc group (p<0.001); however, the rate was increased when the liver graft CIT was<8 h. For recipients with MELD scores ≤30, ABOi LT had a prognosis comparable to that of ABOc LT and can be regarded as a feasible option. For recipients with MELD scores ≥40, ABOi should be adopted with caution in emergency cases. For recipients with MELD scores of 31-39, the ABOi LT prognosis was worse. However, those patients benefited from receiving ABOi grafts with a CIT of <8 h.

Trends in the survival benefit of repeat kidney transplantation over the past 3 decades

Repeat kidney transplantation (re-KT) is the preferred treatment for patients with graft failure. Changing allocation policies, widening the risk profile of recipients, and improving dialysis care may have altered the survival benefit of a re-KT. We characterized trends in re-KT survival benefit over 3 decades and tested whether it differed by age, race/ethnicity, sex, and panel reactive assay (PRA). By using the Scientific Registry of Transplant Recipient data, we identified 25 419 patients who underwent a re-KT from 1990 to 2019 and 25 419 waitlisted counterfactuals from the same year with the same waitlisted time following graft failure. In the adjusted analysis, a re-KT was associated with a lower risk of death (adjusted hazard ratio [aHR] = 0.63; 95% confidence interval [CI], 0.61-0.65). By using the 1990-1994 era as a reference (aHR = 0.77; 95% CI, 0.69-0.85), incremental improvements in the survival benefit were noted (1995-1999: aHR = 0.72; 95% CI, 0.67-0.78: 2000-2004: aHR = 0.59; 95% CI, 0.55-0.63: 2005-2009: aHR = 0.59; 95% CI, 0.56-0.63: 2010-2014: aHR = 0.57; 95% CI, 0.53-0.62: 2015-2019: aHR = 0.64; 95% CI, 0.57-0.73). The survival benefit of a re-KT was noted in both younger (age = 18-64 years: aHR = 0.63; 95% CI, 0.61-0.65) and older patients (age ≥65 years: aHR = 0.66; 95% CI, 0.58-0.74; Pinteraction = .45). Patients of all races/ethnicities demonstrated similar benefits with a re-KT. However, it varied by the sex of the recipient (female patients: aHR = 0.60; 95% CI, 0.56-0.63: male patients: aHR = 0.66; 95% CI, 0.63-0.68; Pinteraction = .004) and PRA (0-20: aHR = 0.69; 95% CI, 0.65-0.74: 21-80: aHR = 0.61; 95% CI, 0.57-0.66; Pinteraction = .02; >80: aHR = 0.57; 95% CI, 0.53-0.61; Pinteraction< .001). Our findings support the continued practice of a re-KT and efforts to overcome the medical, immunologic, and surgical challenges of a re-KT.