Improving outcomes for donation after circulatory death kidney transplantation: Science of the times
| Autor: | Jacqueline van de Wetering, Ian P.J. Alwayn, Arjan D. van Zuilen, Frederike J. Bemelman, Rutger J. Ploeg, Alexander F. Schaapherder, Maarten H. L. Christiaans, Marije C. Baas, Esther Bastiaannet, Azam S. Nurmohamed, Michèle J. C. de Kok, Aiko P. J. de Vries, Jan H.N. Lindeman, Stefan P Berger |
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| Přispěvatelé: | Groningen Institute for Organ Transplantation (GIOT), Groningen Kidney Center (GKC), Interne Geneeskunde, MUMC+: MA Nefrologie (9), RS: NUTRIM - R3 - Respiratory & Age-related Health, AII - Inflammatory diseases, ACS - Diabetes & metabolism, Nephrology, APH - Aging & Later Life, Internal Medicine |
| Rok vydání: | 2020 |
| Předmět: |
Graft Rejection
Pediatrics Multivariate analysis Epidemiology Social Sciences 030230 surgery Organ transplantation 0302 clinical medicine Mathematical and Statistical Techniques Cognition Odds Ratio Medicine and Health Sciences Renal Transplantation Psychology 030212 general & internal medicine UK Kidney transplantation Netherlands RISK Kidney Multidisciplinary Graft Survival Statistics Middle Aged Tissue Donors medicine.anatomical_structure Treatment Outcome CARDIAC DEATH Physical Sciences Medicine Anatomy Glomerular Filtration Rate Research Article Adult medicine.medical_specialty Brain Death Tissue and Organ Procurement Science Decision Making Renal function Delayed Graft Function Surgical and Invasive Medical Procedures Research and Analysis Methods Urinary System Procedures 03 medical and health sciences All institutes and research themes of the Radboud University Medical Center medicine Humans Statistical Methods DONOR KIDNEYS Proportional Hazards Models Transplantation Proportional hazards model business.industry Cognitive Psychology Biology and Life Sciences Retrospective cohort study Kidneys Odds ratio Organ Transplantation Renal System medicine.disease Kidney Transplantation Death Sudden Cardiac Medical Risk Factors COLD ISCHEMIA Multivariate Analysis Kidney Failure Chronic Cognitive Science Renal disorders Radboud Institute for Health Sciences [Radboudumc 11] business Mathematics Neuroscience |
| Zdroj: | PLoS One, 15, 7 PLoS ONE, 15(7):e0236662. PUBLIC LIBRARY SCIENCE PLoS One, 15 PLOS ONE, 15(7):0236662. Public Library of Science de Kok, M J C, Schaapherder, A F M, Alwayn, I P J, Bemelman, F J, van de Wetering, J, van Zuilen, A D, Christiaans, M H L, Baas, M C, Nurmohamed, A S, Berger, S P, Bastiaannet, E, Ploeg, R J, de Vries, A P J & Lindeman, J H N 2020, ' Improving outcomes for donation after circulatory death kidney transplantation : Science of the times ', PLoS ONE, vol. 15, no. 7 July, e0236662 . https://doi.org/10.1371/journal.pone.0236662 PLoS ONE, 15(7). PUBLIC LIBRARY SCIENCE PLoS ONE PLoS ONE, 15(7 July):e0236662. Public Library of Science PLoS One (print), 15(7):e0236662. Public Library of Science PLoS ONE, Vol 15, Iss 7, p e0236662 (2020) |
| ISSN: | 1990-2018 1932-6203 |
| Popis: | The use of kidneys donated after circulatory death (DCD) remains controversial due to concerns with regard to high incidences of early graft loss, delayed graft function (DGF), and impaired graft survival. As these concerns are mainly based on data from historical cohorts, they are prone to time-related effects and may therefore not apply to the current timeframe. To assess the impact of time on outcomes, we performed a time-dependent comparative analysis of outcomes of DCD and donation after brain death (DBD) kidney transplantations. Data of all 11,415 deceased-donor kidney transplantations performed in The Netherlands between 1990-2018 were collected. Based on the incidences of early graft loss, two eras were defined (1998-2008 [n = 3,499] and 2008-2018 [n = 3,781]), and potential time-related effects on outcomes evaluated. Multivariate analyses were applied to examine associations between donor type and outcomes. Interaction tests were used to explore presence of effect modification. Results show clear time-related effects on posttransplant outcomes. The 1998-2008 interval showed compromised outcomes for DCD procedures (higher incidences of DGF and early graft loss, impaired 1-year renal function, and inferior graft survival), whereas DBD and DCD outcome equivalence was observed for the 2008-2018 interval. This occurred despite persistently high incidences of DGF in DCD grafts, and more adverse recipient and donor risk profiles (recipients were 6 years older and the KDRI increased from 1.23 to 1.39 and from 1.35 to 1.49 for DBD and DCD donors). In contrast, the median cold ischaemic period decreased from 20 to 15 hours. This national study shows major improvements in outcomes of transplanted DCD kidneys over time. The time-dependent shift underpins that kidney transplantation has come of age and DCD results are nowadays comparable to DBD transplants. It also calls for careful interpretation of conclusions based on historical cohorts, and emphasises that retrospective studies should correct for time-related effects. |
| Databáze: | OpenAIRE |
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