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Impact of pre-transplant biopsy on 5-year outcomes of expanded criteria donor kidney transplantation.
- Source :
-
Nephrology (Carlton, Vic.) [Nephrology (Carlton)] 2021 Jan; Vol. 26 (1), pp. 70-77. Date of Electronic Publication: 2020 Oct 08. - Publication Year :
- 2021
-
Abstract
- Aim: Compared to Standard Criteria Donors (SCD), Expanded Criteria Donor (ECD) kidneys are associated with poorer outcomes, although pre-transplant biopsy may mitigate risks. This study assessed 5-year outcomes of deceased-donor kidney transplant recipients, comparing recipients of ECD allografts evaluated histologically to recipients of SCD and ECD kidneys assessed clinically.<br />Methods: This is a single-centre retrospective study. From November 2005 to December 2009 (Era 1), donors were assessed clinically for suitability for kidney donation. From December 2009 to October 2017 (Era 2), kidneys from ECDs and diabetics underwent pre-transplant biopsy and were allocated based on Remuzzi score. Outcomes of Era 1 and 2 recipients were compared.<br />Results: ECD kidney transplantation increased from 30.4% to 40.0% from Era 1 to 2. Univariable Cox regression, stratified by transplant era, found that 5-year graft loss was highest with Era 1 ECD (HR 2.5, 95% CI 1.1-5.5, P = .027) while graft loss for Era 2 ECD recipients was similar to SCD recipients. There was no difference in 5-year recipient survival. Amongst Era 1 ECD recipients, 51.2% experienced rejection compared to 30.8-41.5% for other subgroups. Five-year eGFR was higher with Era 2 ECD at 48.4 (33.3-60.7) ml/min/1.73 m <superscript>2</superscript> compared to 42.2 (35.8-57.3) ml/min/1.73 m <superscript>2</superscript> for Era 1 ECD. However, these differences were not statistically significant.<br />Conclusion: Introduction of pre-transplant biopsy assessment may be associated with improved outcomes of ECD kidney recipients such that they are now comparable to SCD kidney recipients, with benefits persisting over 5 years.<br /> (© 2020 Asian Pacific Society of Nephrology.)
- Subjects :
- Adult
Female
Humans
Kidney Function Tests methods
Kidney Function Tests statistics & numerical data
Male
Risk Assessment methods
Risk Factors
Singapore epidemiology
Survival Analysis
Tissue Donors statistics & numerical data
Biopsy adverse effects
Biopsy methods
Donor Selection methods
Donor Selection standards
Graft Rejection epidemiology
Kidney pathology
Kidney physiopathology
Kidney Failure, Chronic epidemiology
Kidney Failure, Chronic surgery
Kidney Transplantation adverse effects
Kidney Transplantation methods
Kidney Transplantation standards
Kidney Transplantation statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1440-1797
- Volume :
- 26
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Nephrology (Carlton, Vic.)
- Publication Type :
- Academic Journal
- Accession number :
- 32986301
- Full Text :
- https://doi.org/10.1111/nep.13788