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1. Early outcomes of kidney transplantation from elderly donors after circulatory death (GEODAS study)

Author

Pérez-Sáez, María José, Lafuente Covarrubias, O., Moreso, Francesc., Melilli, Edoardo, Juega-Marino, F.J, De Sousa, E., López-Sánchez, P., Rodríguez-Ferrero, M.L., Maruri-Kareaga, N., Navarro, M.D., Valero, R., Mazuecos, M.A., Llamas, F., Martín-Moreno, P., Fernández-García, A., Espí, J., Jiménez, C., Ramos, A., Gavela, E., Pascual, Julio, Portolés, J.M., Covarrubias, O.L., Sánchez-Sobrino, B., Santos, J.P., Zapatero, A., Hernández Marrero, Domingo, Manonelles, A., Lauzurica, R., De Souza, E., Diekmann, F., Zárraga, S., Rodríguez-Benot, A., Ruiz, J.C., Alonso, Á., Beneyto, I., López-Oliva, M., and Sancho-Calabuig, A.

Abstract

Background: Spain has dramatically increased the number of controlled circulatory death donors (cDCD). The initial selection criteria for considering cDCD for kidney transplantation (KT) have been expanded progressively, with practically no limits in donor age during the last years. We aimed to analyze the early clinical outcomes using expanded (> 65 years) cDCD in comparison with standard ones. Methods: Observational multicenter study including 19 transplant centers in Spain. We performed a systematic inclusion in a central database of every KT from expanded cDCD at each participant unit from January-2012 to January-2017. Surgical procedures and immunosuppressive protocols were based on local practices. Data was analyzed in the central office using logistic and Cox regression or competitive-risk models for multivariate analysis. Median time of follow-up was 18.1 months. Results: 561 KT were performed with kidneys from cDCD, 135 from donors older than 65 years. As expected, recipients from older cDCD were also older (65.8 (SD 8.8) vs 53.7 (SD 11.4) years; p < 0.001) and with higher comorbidity. At 1 year, no differences were found amongst older and younger cDCD KT recipients in terms of serum creatinine (1.6 (SD 0.7) vs 1.5 (SD 0.8) mg/dl; p = 0.29). Non-death censored graft survival was inferior, but death-censored graft survival was not different (95.5 vs 98.2% respectively; p = 0.481). They also presented a trend towards higher delayed graft function (55.4 vs 46.7%; p = 0.09) but a similar rate of primary non-function (3.7 vs 3.1%; p = 0.71), and acute rejection (3.0 vs 6.3%; p = 0.135). In the multivariate analysis, in short follow-up, donor age was not related with worse survival or poor kidney function (eGFR < 30 ml/min). Conclusions: The use of kidneys from expanded cDCD is increasing for older and comorbid patients. Short-term graft outcomes are similar for expanded and standard cDCD, so they constitute a good-enough source of kidneys to improve the options of KT wait-listed patients.

Published
2019

2. TRANSPLANTATION CLINICAL 1

Author

Schachtner, T., primary, Reinke, P., additional, Dorje, C., additional, Mjoen, G., additional, Midtvedt, K., additional, Strom, E. H., additional, Oyen, O., additional, Jenssen, T., additional, Reisaeter, A. V., additional, Smedbraaten, Y. V., additional, Sagedal, S., additional, Fagerland, M. W., additional, Hartmann, A., additional, Thiel, S., additional, Zulkarnaev, A., additional, Vatazin, A., additional, Vincenti, F., additional, Harel, E., additional, Kantor, A., additional, Thurison, T., additional, Hoyer-Hansen, G., additional, Craik, C., additional, Kute, V. B., additional, Shah, P. S., additional, Vanikar, A. V., additional, Modi, P. R., additional, Shah, P. R., additional, Gumber, M. R., additional, Patel, H. V., additional, Engineer, D. P., additional, Shah, V. R., additional, Rizvi, J., additional, Trivedi, H. L., additional, Malheiro, J., additional, Dias, L., additional, Martins, L. S., additional, Fonseca, I., additional, Pedroso, S., additional, Almeida, M., additional, Castro-Henriques, A., additional, Cabrita, A., additional, Costa, C., additional, Ritta, M., additional, Sinesi, F., additional, Sidoti, F., additional, Mantovani, S., additional, Di Nauta, A., additional, Messina, M., additional, Cavallo, R., additional, Verflova, A., additional, Svobodova, E., additional, Slatinska, J., additional, Slavcev, A., additional, Pokorna, E., additional, Viklicky, O., additional, Yagan, J., additional, Chandraker, A., additional, Diena, D., additional, Tognarelli, G., additional, Ranghino, A., additional, Bussolino, S., additional, Fop, F., additional, Segoloni, G. P., additional, Biancone, L., additional, Leone, F., additional, Mauro, M. V., additional, Gigliotti, P., additional, Lofaro, D., additional, Greco, F., additional, Perugini, D., additional, Papalia, T., additional, Perri, A., additional, Vizza, D., additional, Giraldi, C., additional, Bonofilgio, R., additional, Luis-Lima, S., additional, Marrero, D., additional, Gonzalez-Rinne, A., additional, Torres, A., additional, Salido, E., additional, Jimenez-Sosa, A., additional, Aldea-Perona, A., additional, Gonzalez-Posada, J. M., additional, Perez-Tamajon, L., additional, Rodriguez-Hernandez, A., additional, Negrin-Mena, N., additional, Porrini, E., additional, Pihlstrom, H., additional, Dahle, D. O., additional, Holdaas, H., additional, Von Der Lippe, N., additional, Waldum, B., additional, Brekke, F., additional, Amro, A., additional, Os, I., additional, Klin, P., additional, Sanabria, H., additional, Bridoux, P., additional, De Francesco, J., additional, Fortunato, R. M., additional, Raffaele, P., additional, Kong, J., additional, Son, S. H., additional, Kwon, H. Y., additional, Whang, E. J., additional, Choi, W. Y., additional, Yoon, C. S., additional, Thanaraj, V., additional, Theakstone, A., additional, Stopper, K., additional, Ferraro, A., additional, Bhattacharjya, S., additional, Devonald, M., additional, Williams, A., additional, Mella, A., additional, Gallo, E., additional, Di Vico, M. C., additional, Pagani, F., additional, Gai, M., additional, Cho, H. J., additional, Nho, K. W., additional, Park, S.-K., additional, Kim, S. B., additional, Yoshida, K., additional, Ishii, D., additional, Ohyama, T., additional, Kohguchi, D., additional, Takeuchi, Y., additional, Varga, A., additional, Sandor, B., additional, Kalmar-Nagy, K., additional, Toth, A., additional, Toth, K., additional, Szakaly, P., additional, Kildushevsky, A., additional, Fedulkina, V., additional, Kantaria, R., additional, Staeck, O., additional, Halleck, F., additional, Rissling, O., additional, Naik, M., additional, Neumayer, H.-H., additional, Budde, K., additional, Khadzhynov, D., additional, Bhadauria, D., additional, Kaul, A., additional, Prasad, N., additional, Sharma, R. K., additional, Sezer, S., additional, Bal, Z., additional, Erkmen Uyar, M., additional, Guliyev, O., additional, Erdemir, B., additional, Colak, T., additional, Ozdemir, N., additional, Haberal, M., additional, Caliskan, Y., additional, Yazici, H., additional, Artan, A. S., additional, Oto, O. A., additional, Aysuna, N., additional, Bozfakioglu, S., additional, Turkmen, A., additional, Yildiz, A., additional, Sever, M. S., additional, Yagisawa, T., additional, Nukui, A., additional, Kimura, T., additional, Nannmoku, K., additional, Kurosawa, A., additional, Sakuma, Y., additional, Miki, A., additional, Damiano, F., additional, Ligabue, G., additional, De Biasi, S., additional, Granito, M., additional, Cossarizza, A., additional, Cappelli, G., additional, Henriques, A. C., additional, Davide, J., additional, Von During, M. E., additional, Jenssen, T. G., additional, Bollerslev, J., additional, Godang, K., additional, Asberg, A., additional, Bachelet, T., additional, Martinez, C., additional, Bello, A., additional, Kejji, S., additional, Couzi, L., additional, Guidicelli, G., additional, Lepreux, S., additional, Visentin, J., additional, Congy-Jolivet, N., additional, Rostaing, L., additional, Taupin, J.-L., additional, Kamar, N., additional, Merville, P., additional, Ozdemir, H., additional, Yildirim, S., additional, Tutal, E., additional, Sayin, B., additional, Ozdemir Acar, N., additional, Banasik, M., additional, Boratynska, M., additional, Koscielska-Kasprzak, K., additional, Kaminska, D., additional, Bartoszek, D., additional, Mazanowska, O., additional, Krajewska, M., additional, Zmonarski, S., additional, Chudoba, P., additional, Dawiskiba, T., additional, Protasiewicz, M., additional, Halon, A., additional, Sas, A., additional, Kaminska, M., additional, Klinger, M., additional, Stefanovic, N., additional, Cvetkovic, T., additional, Velickovic - Radovanovic, R., additional, Jevtovic - Stoimenov, T., additional, Vlahovic, P., additional, Rungta, R., additional, Das, P., additional, Ray, D. S., additional, Gupta, S., additional, Kolonko, A., additional, Szotowska, M., additional, Kuczera, P., additional, Chudek, J., additional, Wiecek, A., additional, Sikora-Grabka, E., additional, Adamczak, M., additional, Madej, P., additional, Amanova, A., additional, Kendi Celebi, Z., additional, Bakar, F., additional, Caglayan, M. G., additional, Keven, K., additional, Massimetti, C., additional, Imperato, G., additional, Zampi, G., additional, De Vincenzi, A., additional, Fabbri, G. D. D., additional, Brescia, F., additional, Feriozzi, S., additional, Filipov, J. J., additional, Zlatkov, B. K., additional, Dimitrov, E. P., additional, Svinarov, D. A., additional, Poesen, R., additional, De Vusser, K., additional, Evenepoel, P., additional, Kuypers, D., additional, Naesens, M., additional, Meijers, B., additional, Kocak, H., additional, Yilmaz, V. T., additional, Yilmaz, F., additional, Uslu, H. B., additional, Aliosmanoglu, I., additional, Ermis, H., additional, Dinckan, A., additional, Cetinkaya, R., additional, Ersoy, F. F., additional, Suleymanlar, G., additional, Oliveira, J.-C., additional, Santos, J., additional, Lobato, L., additional, Mendonca, D., additional, Watarai, Y., additional, Yamamoto, T., additional, Tsujita, M., additional, Hiramitsu, T., additional, Goto, N., additional, Narumi, S., additional, Kobayashi, T., additional, Line, P.-D., additional, Housawi, A., additional, House, A., additional, Ng, C., additional, Denesyk, K., additional, Rehman, F., additional, Moist, L., additional, Musetti, C., additional, Battista, M., additional, Izzo, C., additional, Guglielmetti, G., additional, Airoldi, A., additional, Stratta, P., additional, Cena, T., additional, Quaglia, M., additional, Fenoglio, R., additional, Cagna, D., additional, Amoroso, A., additional, Palmisano, A., additional, Degli Antoni, A. M., additional, Vaglio, A., additional, Piotti, G., additional, Cremaschi, E., additional, Buzio, C., additional, Maggiore, U., additional, Lee, M.-C., additional, Hsu, B.-G., additional, Zalamea Jarrin, F., additional, Sanchez Sobrino, B., additional, Lafuente Covarrubias, O., additional, Karsten Alvarez, S., additional, Dominguez Apinaniz, P., additional, Llopez Carratala, R., additional, Portoles Perez, J., additional, Yildirim, T., additional, Yilmaz, R., additional, Turkmen, E., additional, Altindal, M., additional, Arici, M., additional, Altun, B., additional, Erdem, Y., additional, Dounousi, E., additional, Mitsis, M., additional, Naka, K., additional, Pappas, H., additional, Lakkas, L., additional, Harisis, H., additional, Pappas, K., additional, Koutlas, V., additional, Tzalavra, I., additional, Spanos, G., additional, Michalis, L., additional, Siamopoulos, K., additional, Iwabuchi, T., additional, Nanmoku, K., additional, Yasunaru, S., additional, Yoshikawa, M., additional, Kitamura, K., additional, Fuji, H., additional, Fujisawa, M., additional, Nishi, S., additional, Carta, P., additional, Zanazzi, M., additional, Buti, E., additional, Larti, A., additional, Caroti, L., additional, Di Maria, L., additional, Minetti, E. E., additional, Shi, Y., additional, Luo, L., additional, Cai, B., additional, Wang, T., additional, Zou, Y., additional, Wang, L., additional, Kim, Y., additional, Kim, H. S., additional, Choi, B. S., additional, Park, C. W., additional, Yang, C. W., additional, Kim, Y.-S., additional, Chung, B. H., additional, Baek, C. H., additional, Kim, M., additional, Kim, J.-S., additional, Yang, W. S., additional, Han, D. J., additional, Mikolasevic, I., additional, Racki, S., additional, Lukenda, V., additional, Persic, M. P., additional, Colic, M., additional, Devcic, B., additional, Orlic, L., additional, Gurlek Demirci, B., additional, Say N, C. B., additional, Ozdemir Acar, F. N., additional, Vali, S., additional, Ismal, K., additional, Sahay, M., additional, Civiletti, F., additional, Cantaluppi, V., additional, Medica, D., additional, Mazzeo, A. T., additional, Assenzio, B., additional, Mastromauro, I., additional, Deambrosis, I., additional, Giaretta, F., additional, Fanelli, V., additional, Mascia, L., additional, Gkirdis, I., additional, Bechlioulis, A., additional, Evangelou, D., additional, Zarzoulas, F., additional, Kotsia, A., additional, Balafa, O., additional, Tzeltzes, G., additional, Nakas, G., additional, Kalaitzidis, R., additional, Katsouras, C., additional, Uyanik, S., additional, Toprak, S. K., additional, Ilhan, O., additional, Ekmen Uyar, M., additional, Hernandez Vargas, H., additional, Artamendi Larranaga, M., additional, Ramalle Gomara, E., additional, Gil Catalinas, F., additional, Bello Ovalle, A., additional, Pimentel Guzman, G., additional, Coloma Lopez, A., additional, Sierra Carpio, M., additional, Gil Paraiso, A., additional, Dall Anesse, C., additional, Beired Val, I., additional, Huarte Loza, E., additional, Choy, B. Y., additional, Kwan, L., additional, Mok, M., additional, Chan, T. M., additional, Yamakawa, T., additional, Kobayashi, A., additional, Yamamoto, I., additional, Mafune, A., additional, Nakada, Y., additional, Tannno, Y., additional, Tsuboi, N., additional, Yamamoto, H., additional, Yokoyama, K., additional, Ohkido, I., additional, Yokoo, T., additional, Luque, Y., additional, Anglicheau, D., additional, Rabant, M., additional, Clement, R., additional, Kreis, H., additional, Sartorius, A., additional, Noel, L.-H., additional, Timsit, M.-O., additional, Legendre, C., additional, Rancic, N., additional, Vavic, N., additional, Dragojevic-Simic, V., additional, Katic, J., additional, Jacimovic, N., additional, Kovacevic, A., additional, Mikov, M., additional, Veldhuijzen, N. M. H., additional, Rookmaaker, M. B., additional, Van Zuilen, A. D., additional, Nquyen, T. Q., additional, Boer, W. H., additional, Sahtout, W., additional, Ghezaiel, H., additional, Azzebi, A., additional, Ben Abdelkrim, S., additional, Guedri, Y., additional, Mrabet, S., additional, Nouira, S., additional, Ferdaws, S., additional, Amor, S., additional, Belarbia, A., additional, Zellama, D., additional, Mokni, M., additional, Achour, A., additional, Parikova, A., additional, Hanzal, V., additional, Fronek, J., additional, Orandi, B. J., additional, James, N. T., additional, Montgomery, R. A., additional, Desai, N. M., additional, Segev, D. L., additional, Fontana, F., additional, Ballestri, M., additional, and Magistroni, R., additional

Published
2014
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3. Early outcomes of kidney transplantation from elderly donors after circulatory death (GEODAS study).

Author

Pérez-Sáez MJ, Lafuente Covarrubias O, Hernández D, Moreso F, Melilli E, Juega J, de Sousa E, López-Sánchez P, Rodríguez-Ferrero ML, Maruri-Kareaga N, Navarro MD, Valero R, Mazuecos MA, Llamas F, Martín-Moreno P, Fernández-García A, Espí J, Jiménez C, Ramos A, Gavela E, Pascual J, and Portolés JM

Subjects
Age Factors, Aged, Donor Selection trends, Female, Humans, Kidney Transplantation trends, Male, Middle Aged, Registries, Shock diagnosis, Spain epidemiology, Survival Rate trends, Treatment Outcome, Donor Selection methods, Graft Survival physiology, Kidney Transplantation mortality, Shock mortality, Tissue Donors
Abstract

Background: Spain has dramatically increased the number of controlled circulatory death donors (cDCD). The initial selection criteria for considering cDCD for kidney transplantation (KT) have been expanded progressively, with practically no limits in donor age during the last years. We aimed to analyze the early clinical outcomes using expanded (> 65 years) cDCD in comparison with standard ones., Methods: Observational multicenter study including 19 transplant centers in Spain. We performed a systematic inclusion in a central database of every KT from expanded cDCD at each participant unit from January-2012 to January-2017. Surgical procedures and immunosuppressive protocols were based on local practices. Data was analyzed in the central office using logistic and Cox regression or competitive-risk models for multivariate analysis. Median time of follow-up was 18.1 months., Results: 561 KT were performed with kidneys from cDCD, 135 from donors older than 65 years. As expected, recipients from older cDCD were also older (65.8 (SD 8.8) vs 53.7 (SD 11.4) years; p < 0.001) and with higher comorbidity. At 1 year, no differences were found amongst older and younger cDCD KT recipients in terms of serum creatinine (1.6 (SD 0.7) vs 1.5 (SD 0.8) mg/dl; p = 0.29). Non-death censored graft survival was inferior, but death-censored graft survival was not different (95.5 vs 98.2% respectively; p = 0.481). They also presented a trend towards higher delayed graft function (55.4 vs 46.7%; p = 0.09) but a similar rate of primary non-function (3.7 vs 3.1%; p = 0.71), and acute rejection (3.0 vs 6.3%; p = 0.135). In the multivariate analysis, in short follow-up, donor age was not related with worse survival or poor kidney function (eGFR < 30 ml/min)., Conclusions: The use of kidneys from expanded cDCD is increasing for older and comorbid patients. Short-term graft outcomes are similar for expanded and standard cDCD, so they constitute a good-enough source of kidneys to improve the options of KT wait-listed patients.

Published
2019
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4. Kidney transplant from controlled donors following circulatory death: Results from the GEODAS-3 multicentre study.

Author

Portolés JM, Pérez-Sáez MJ, López-Sánchez P, Lafuente-Covarrubias O, Juega J, Hernández D, Espí J, Navarro MD, Mazuecos MA, Rodríguez-Ferrero ML, Maruri-Kareaga N, Moreso F, Melilli E, de Souza E, Ruiz JC, Llamas F, Gutiérrez-Dalmau A, Guirado L, Martín-Moreno P, Pérez Flores I, Fernández-García A, Jiménez C, Gavela E, Ramos A, and Pascual J

Subjects
Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Cause of Death, Child, Child, Preschool, Cold Ischemia adverse effects, Cold Ischemia statistics & numerical data, Delayed Graft Function epidemiology, Delayed Graft Function etiology, Female, Glomerular Filtration Rate, Graft Survival, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Organ Preservation methods, Retrospective Studies, Spain, Time Factors, Transplant Recipients statistics & numerical data, Treatment Outcome, Young Adult, Heart Arrest mortality, Kidney Transplantation mortality, Kidney Transplantation statistics & numerical data, Tissue Donors statistics & numerical data
Abstract

Introduction: Many European countries have transplant programmes with controlled donors after cardiac death (cDCD). Twenty-two centres are part of GEODAS group. We analysed clinical results from a nephrological perspective., Methods: Observational, retrospective and multicentre study with systematic inclusion of all kidney transplant recipients from cDCD, following local protocols regarding extraction and immunosuppression., Results: A total of 335 cDCD donors (mean age 57.2 years) whose deaths were mainly due to cardiovascular events were included. Finally, 566 recipients (mean age 56.5 years; 91.9% first kidney transplant) were analysed with a median of follow-up of 1.9 years. Induction therapy was almost universal (thymoglobulin 67.4%; simulect 32.8%) with maintenance with prednisone-MMF-tacrolimus (91.3%) or combinations with mTOR (6.5%). Mean cold ischaemia time (CIT) was 12.3h. Approximately 3.4% (n=19) of recipients experienced primary non-function, essentially associated with CIT (only CIT ≥ 14 h was associated with primary non-function). Delayed graft function (DGF) was 48.8%. DGF risk factors were CIT ≥ 14 h OR 1.6, previous haemodialysis (vs. peritoneal dialysis) OR 2.1 and donor age OR 1.01 (per year). Twenty-one patients (3.7%) died with a functioning graft, with a recipient and death-censored graft survival at 2-years of 95% and 95.1%, respectively. The estimated glomerular filtration rate at one year of follow-up was 60.9 ml/min., Conclusions: CIT is a modifiable factor for improving the incidence of primary non-function in kidney transplant arising from cDCD. cDCD kidney transplant recipients have higher delayed graft function rate, but the same patient and graft survival compared to brain-dead donation in historical references. These results are convincing enough to continue fostering this type of donation., (Copyright © 2018 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

Published
2019
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5. Development of a program for kidney transplants using organs donated from donors awaiting cardiac arrest (type III Maastricht).

Author

Portolés-Pérez J, Rubio-Muñoz JJ, Lafuente-Covarrubias O, Sánchez-Sobrino B, Carballido-Rodríguez J, Rodríguez-Reina G, Rengifo-Abadd D, Medina-Carrizo A, Sanz-Moreno C, and Fernández-Fernández J

Subjects
Aged, Female, Humans, Male, Middle Aged, Program Development, Heart Arrest classification, Kidney Transplantation, Tissue Donors, Tissue and Organ Procurement methods
Abstract

Introduction: The availability of organ donors is a limiting factor for kidney transplants. Donations from non-heart-beating donors (NHBD) can provide as many as one-third of all organs. Controlled patients awaiting cardiac arrest following limitation of life support techniques, or type III Maastricht donors, constitute an alternative that still has yet to be systematically developed., Study Type: Descriptive series of 10 cases occurring between January and April 2012., Method: Over a period of 6 months, we designed a protocol for extracting and managing kidney transplants and providing immunosuppression therapy. Patients are evaluated in accordance with the criteria agreed by a different team responsible for transplant coordination. We established a maximum duration of time between limitation of life-sustaining therapy and death of 120 minutes and 60 minutes warm ischaemia. Two types of graft perfusion were used, one in situ through direct application to the surgical area, and another using ante mortem vascular canalisation. Immunosuppression therapy included induction with thymoglobulin, steroids, and mycophenolate, with introduction of tacrolimus on the seventh day. Data are expressed as median and (range)., Results: We included the first 10 cases of kidney transplants with organs from 5 NHBD (type III Maastricht): 4 males, mean age of 57 years (45-66 years), with limitation of life-sustaining therapy due to anoxic encephalopathy (2), intoxication (1), acute stroke (2) and terminal respiratory failure (1). The following mean time intervals were recorded: effective warm ischaemia: 20 minutes (8-23 minutes) and cold ischaemia: 7.5 hours (4-14.1 hours). Recipients had a mean age of 58 years (32-71 years), with various aetiologies (2 cases of glomerulonephritis, 1 polycystic kidney disease, 2 tubulo-interstitial nephropathy, 4 vascular, and 1 unknown), with a mean 31.7 months on haemodialysis (11-84 months); the kidney was a second transplant in two cases. No patients were hyper-immunised. Six patients required a dialysis session at some point, and four had prolonged acute tubular necrosis, over a mean hospitalisation period of 24.5 days (8-44 days). Mean creatinine (Cr) one month after transplantation was 2.1mg/dl (0.7-3.2mg/dl), and mean nadir creatinine was 1.2mg/dl (0.7-3.2mg/dl). One patient did not improve upon Cr values <3.2mg/dl, despite the absence of evidence of toxicity or rejection in a renal biopsy, and the transplant pair reached a Cr of 1.4mg/dl. Throughout the series, similar surgical complications were recorded to those observed in conventional donor situations., Conclusions: Despite the limitations of this preliminary study, the use of this type of transplant produces favourable short-term evolution. Expanded use of this type of donor could reduce the waiting-list time for a kidney transplant.

Published
2012
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