Living-Donor Kidney Transplantation Performed in a Low-Volume Center by Visiting Surgeons From a High-Volume Center and Managed Clinically Solely by Nephrologists: 1-Year Outcomes
| Autor: | Tomokazu Shimizu, Shunichi Furuhata, Kazunari Tanabe, Hiromi Shinohara, Minoru Murakami, Masaya Ikezoe, Hideki Ishida, Kosuke Osawa, Yuhei Ichikawa, Hiroki Shirakawa, Kazuki Yanagisawa, Shoichi Iida, Toshihito Hirai, Kazuya Omoto |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Hospitals Low-Volume Living donor Antibodies Nephrologists Postoperative Complications Japan Outcome Assessment Health Care medicine Living Donors Humans Center (algebra and category theory) Kidney transplantation Retrospective Studies Surgeons Transplantation Adult patients business.industry Graft Survival Retrospective cohort study Middle Aged medicine.disease Kidney Transplantation Confidence interval Surgery Low volume Propensity score matching Female business Hospitals High-Volume |
| Zdroj: | Transplantation proceedings. 53(3) |
| ISSN: | 1873-2623 |
| Popis: | Background Little is known about the outcome of living-donor kidney transplantation (LDKT) performed in low-volume centers lacking the services of full-time transplant surgeons. This retrospective cohort study assessed the outcome of LDKT performed in a low-volume center by visiting transplant surgeons from a high-volume center and managed perioperatively by transplant nephrologists. Methods We compared Japanese adult patients who had no donor-specific antibodies and underwent LDKT between 2006 and 2015 either in a low-volume (n = 31) or high-volume (n = 481) center. In the low-volume center, visiting transplant surgeons from the high-volume center conducted LDKT and transplant nephrologists managed the recipients peri- and postoperatively. The primary outcome was the composite of infection, cardiovascular disease, or cancer during 1-year follow-up. The outcomes of the low- and high-volume centers were compared using 1:2 propensity score matching. Results After matching, 9 of 29 patients in the low-volume center (31.0%) and 16 of 58 patients in the high-volume center (27.6%) experienced the primary composite outcome (risk ratio = 1.13; 95% confidence interval, 0.57-2.23). There were no significant differences between the 2 groups in graft function at 1 year, all-cause graft loss, biopsy-proven rejection, and urological complications. However, the median duration of post-LDKT hospitalization was significantly longer in the low-volume center than in the high-volume center (23 and 16 days, respectively). Conclusions Among Japanese patients without preformed donor-specific antibodies, LDKT conducted at a low-volume center by visiting transplant surgeons from a high-volume center and managed clinically by transplant nephrologists was not associated with significantly higher risk of postoperative complications. |
| Databáze: | OpenAIRE |
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