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The article discusses a study on the survival of African American and Caucasian American recipients of kidney allograft. The study shows that African Americans with lupus who receive kidney transplants have high prevalence of predictors of allograft failure, which can explain their poor outcomes. African American and Caucasian Americans have similar allograft failure rates when predictors are matched between groups in lupus recipients of kidney transplants from deceased donors.

Background: Kidney transplantation has been shown to improve life expectancy when compared with remaining on dialysis. However, there is an ever-expanding shortage of available organs for transplantation. The use of high kidney donor profile index (KDPI; >85) kidneys is 1 strategy to address this shortage. The current study aims to evaluate the advantage of accepting a high KDPI versus a low KDPI kidney (KDPI ≤85) in patients 65 y or older., Methods: A single-center retrospective review of all patients, ages 65 y or older, who underwent deceased donor kidney transplantation between 2010 and 2020 was performed. Outcomes and wait times of recipients undergoing low KDPI (KDPI ≤85) versus high KDPI (KDPI >85) kidney transplantation were compared. Significance was defined as P  < 0.05., Results: Four hundred ninety-two patients were identified; 317 (64.4%) were men with a median age at transplantation of 69 y. Four hundred five patients received low KDPI kidneys, whereas the remaining received high KDPI grafts. High KDPI kidneys were procured from older donors (60 versus 47, P  < 0.001) and had shorter cold ischemic time (25.0 versus 28.3 h, P  = 0.01) compared with low KDPI kidneys. There was no significant difference in graft and patient survival between low and high KDPI recipients, with 85.1% and 86.2% grafts functioning at a follow-up of 4.85 (2.9-7.0) y, respectively. Pretransplant wait time was significantly shorter in the high KDPI group (2.7 [1.8-4.1] versus 3.5 [2.3-4.8] y; P  = 0.004)., Conclusions: In patients 65 y or older undergoing deceased donor kidney transplantation, high KDPI kidneys may offer shorter pretransplant waiting times without compromising graft or patient survival., (Copyright © 2024 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)

Background: The mismatch between the number of patients awaiting kidney transplantation and the supply of donor organs has contributed to the increase in kidney transplantation from donors after circulatory death (DCD). Persistently long waiting times have led the transplant community to continue to explore the use of expanded- criteria DCD kidneys. In parallel, advances in organ preservation strategies have contributed to an overall increase in DCD organ transplantation and are altering the transplant landscape. Some of these techniques may improve kidney allograft outcomes and affect how DCD kidneys are used. We aimed to better understand practices in accepting DCD kidney offers in the modern era., Methods: Directors of 196 US kidney transplant centers were emailed a link to an online survey over a 5-week period., Results: Forty-eight out of the 364 directors (13%) responded, with all United Network for Organ Sharing regions represented. Definitions of warm ischemia time (WIT) used in DCD kidney evaluation varied widely among the respondents. The maximum total WIT limit varied, with 19 (39.6%) <60-minute responses, followed by 16 (33%) <90-minute responses, and 10 (20.8%) <120-minute responses., Conclusions: Despite increasing DCD kidney transplantation volumes in the United States, there are no standardized procurement biopsy practices, organ procurement organization preoperative protocols, or consensus definition or limits of WIT. Agreement on terminology may facilitate rapid clinical communication, efficiency of organ allocation and utilization, recording of data, research, and improvements in policy., Competing Interests: Declaration of competing interest All the authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Current kidney perfusion protocols are not optimized for addressing the ex vivo physiological and metabolic needs of the kidney. Ex vivo normothermic perfusion may be utilized to distinguish high-risk kidneys to determine suitability for transplantation. Here, we assessed the association of tissue metabolic changes with changes in a kidney injury biomarker and functional parameters in eight deceased donor kidneys deemed unsuitable for transplantation during a 12-hour ex vivo normothermic perfusion. The kidneys were grouped into good and poor performers based on blood flow and urine output. The mean age of the deceased kidney donors was 43 years with an average cold ischemia time of 37 hours. Urine output and creatinine clearance progressively increased and peaked at six hours post-perfusion among good performers. Poor performers had 71 ng/ml greater (95% confidence interval 1.5, 140) urinary neutrophil gelatinase-associated lipocalin at six hours compared to good performers corresponding to peak functional differences. Organ performance was distinguished by tissue metabolic differences in branched chain amino acid metabolism and that their tissue levels negatively correlated with urine output among all kidneys at six hours. Tissue lipid profiling showed poor performers were highlighted by the accumulation of membrane structure components including glycerolipids and sphingolipids at early perfusion time points. Thus, we showed that six hours is needed for kidney function recovery during ex vivo normothermic perfusion and that branched chain amino acid metabolism may be a major determinant of organ function and resilience., (Copyright © 2024 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)

Background: Efforts to address the shortage of donor organs include increasing the use of renal allografts from donors after circulatory death (DCD). While warm ischemia time (WIT) is thought to be an important factor in DCD kidney evaluation, few studies have compared the relationship between WIT and DCD kidney outcomes, and WIT acceptance practices remain variable., Methods: We conducted a single-center retrospective review of all adult patients who underwent deceased donor kidney transplantation from 2000 to 2021. We evaluated the impact of varied functional warm ischemia time (fWIT) in controlled DCD donors by comparing donor and recipient characteristics and posttransplant outcomes between high fWIT (>60 min), low fWIT (≤60 min), and kidneys transplanted from donors after brain death (DBD)., Results: Two thousand eight hundred eleven patients were identified, 638 received low fWIT DCD, 93 received high fWIT DCD, and 2080 received DBD kidneys. There was no significant difference in 5-year graft survival between the DCD low fWIT, high fWIT, and DBD groups, with 84%, 83%, and 83% of grafts functioning, respectively. Five-year patient survival was 91% in the low fWIT group, 92% in the high fWIT group, and 90% in the DBD group. An increase in kidney donor risk index (KDRI) (HR 3.37, 95% CI = 2.1-5.7) and high CIT compared to low CIT (HR 2.12, 95% CI = 1.4-3.1) have higher hazard ratios for 1-year graft failure., Conclusions: Increased acceptance of kidneys from selected DCD donors with prolonged fWIT may present an opportunity to increase kidney utilization while preserving outcomes. Our group specifically prioritizes the use of kidneys from younger donors, with lower KDPI, and without acute kidney injury, or risk factors for underlying chronic kidney disease., (© 2024 The Author(s). Clinical Transplantation published by Wiley Periodicals LLC.)