| Autor: |
Cheungpasitporn W; Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA., Thongprayoon C; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA., Vaitla PK; Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA., Chewcharat A; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA., Hansrivijit P; Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17105, USA., Koller FL; Department of Transplant and Hepatobiliary Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA., Mao MA; Division of Nephrology, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA., Bathini T; Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA., Salim SA; Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA., Katari S; Renal Transplant Program, School of Medicine/Saint Luke's Health System, University of Missouri-Kansas City, Kansas City, MO 64110, USA., Cummings LS; Renal Transplant Program, School of Medicine/Saint Luke's Health System, University of Missouri-Kansas City, Kansas City, MO 64110, USA., Island E; Renal Transplant Program, School of Medicine/Saint Luke's Health System, University of Missouri-Kansas City, Kansas City, MO 64110, USA., Forster J; Renal Transplant Program, School of Medicine/Saint Luke's Health System, University of Missouri-Kansas City, Kansas City, MO 64110, USA., Leeaphorn N; Renal Transplant Program, School of Medicine/Saint Luke's Health System, University of Missouri-Kansas City, Kansas City, MO 64110, USA. |
| Abstrakt: |
Background: This study aimed to assess the association between the percentage of glomerulosclerosis (GS) in procurement allograft biopsies from high-risk deceased donor and graft outcomes in kidney transplant recipients. Methods: The UNOS database was used to identify deceased-donor kidneys with a kidney donor profile index (KDPI) score > 85% from 2005 to 2014. Deceased donor kidneys were categorized based on the percentage of GS: 0-10%, 11-20%, >20% and no biopsy performed. The outcome included death-censored graft survival, patient survival, rate of delayed graft function, and 1-year acute rejection. Results: Of 22,006 kidneys, 91.2% were biopsied showing 0-10% GS (58.0%), 11-20% GS (13.5%), >20% GS (19.7%); 8.8% were not biopsied. The rate of kidney discard was 48.5%; 33.6% in 0-10% GS, 68.9% in 11-20% GS, and 77.4% in >20% GS. 49.8% of kidneys were discarded in those that were not biopsied. Death-censored graft survival at 5 years was 75.8% for 0-10% GS, 70.9% for >10% GS, and 74.8% for the no biopsy group. Among kidneys with >10% GS, there was no significant difference in death-censored graft survival between 11-20% GS and >20% GS. Recipients with >10% GS had an increased risk of graft failure (HR = 1.27, p < 0.001), compared with 0-10% GS. There was no significant difference in patient survival, acute rejection at 1-year, and delayed graft function between 0% and 10% GS and >10% GS. Conclusion: In >85% KDPI kidneys, our study suggested that discard rates increased with higher percentages of GS, and GS >10% is an independent prognostic factor for graft failure. Due to organ shortage, future studies are needed to identify strategies to use these marginal kidneys safely and improve outcomes. |
