Simple Cysts in Donor Kidney Contribute to Reduced Allograft Function

2016 ◽  
Vol 45 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Wenxian Qiu ◽  
Yan Jiang ◽  
Jianyong Wu ◽  
Hongfeng Huang ◽  
Wenqing Xie ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Living Donor ◽  
Renal Cysts ◽  
Glomerular Sclerosis ◽  
Donor Kidney ◽  
Surface Area Ratio ◽  
Baseline Serum ◽  
Living Donor Transplantation ◽  
Allograft Function ◽  
Living Donor Kidney

Background: Simple renal cysts may be an early marker of renal disease. We investigated whether simple cysts in donor kidney are associated with the decline of allograft function in living donor kidney transplantation. Methods: We retrospectively reviewed records of donors and recipients from 716 living donor kidney transplants performed between April 2007 and April 2015 in our hospital. Ninety-one donors with renal cysts and 64 recipients with cysts in donor kidney were noted. We compared these 64 cases to 128 no cyst-bearing controls matched for the donor gender, recipient gender, donor baseline serum creatinine (sCr), donor/recipient body surface area ratio, donor age, recipient age and the date of kidney transplantation in turn. Results: The presence of cysts was interrelated with age, gender and renal function independently in donors. Pathological findings of time-zero biopsy revealed that donor kidney harboring cysts existed more glomerular sclerosis compared with no cyst-bearing controls (p = 0.040). The estimating glomerular filtration rate levels of recipients were 80.82 ± 26.61 vs. 88.21 ± 23.12, 66.95 ± 17.42 vs. 72.15 ± 16.42 and 60.92 ± 22.17 vs. 68.72 ± 14.43 ml/min· 1.73 m2 in cyst-bearing and no cyst-bearing group on day 7, month 6 and year 5, respectively, after surgery (p < 0.05). The mean sCr were 112.14 ± 48.32 vs. 98.75 ± 29.71 and 126.28 ± 42.32 vs. 115.05 ± 26.35 μmol/l on the 7th day and a half year after transplant, respectively (p < 0.05). The 2 groups did not significantly differ in terms of the other characteristics. Conclusion: Simple cysts in donor kidney can influence the early and long-term allograft function. In living donor transplantation, kidney presenting cysts should be considered carefully at the time of donor selection.

Renal Cysts in Living Donor Kidney Transplantation: Long-Term Follow-up in 25 Patients

2009 ◽  
Vol 41 (10) ◽  
pp. 4047-4051 ◽  
Author(s):  
D. Grotemeyer ◽  
A. Voiculescu ◽  
F. Iskandar ◽  
M. Voshege ◽  
D. Blondin ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Living Donor ◽  
Renal Cysts ◽  
Donor Kidney ◽  
Living Donor Kidney Transplantation ◽  
Long Term Follow Up ◽  
Donor Kidney Transplantation ◽  
Living Donor Kidney

Tubular Cell Senescence in the Donated Kidney Predicts Allograft Function, but Not Donor Remnant Kidney Function, in Living Donor Kidney Transplantation

2017 ◽  
Vol 47 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Tadashi Sofue ◽  
Yoshio Kushida ◽  
Taro Ozaki ◽  
Masahiro Moritoki ◽  
Yoko Nishijima ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Function ◽  
Living Donor ◽  
Cell Senescence ◽  
Tubular Cell ◽  
Donor Age ◽  
Donor Kidney ◽  
Allograft Function ◽  
Remnant Kidney ◽  
Living Donor Kidney

Background: It is uncertain whether kidneys from marginal donors are suitable for live kidney transplantation. In deceased donor kidneys, tubular cell senescence affects allograft function. However, the degree of cell senescence in a living donor kidney with marginal factors has not been reported. In this study, we assessed the association of tubular cell senescence with allograft and remnant kidney function by a prospective observational clinical study. Methods: Thirty-eight living donor kidney transplantations were analyzed prospectively. Tissue sections obtained from preimplantation kidney biopsies were immunostained for p16INK4a to indicate cell senescence. Various kidney biomarkers were analyzed in urine and blood samples. Results: Of the 38 donors, 21 had marginal factors. Severe tubular senescence was found in living donors with overlapping marginal criteria. Tubular senescence in living donor kidneys was significantly related to donor age and lower recipient kidney function at 1 year after transplantation independently of donor age (β = –0.281; p = 0.050) but did not affect remnant kidney function after donation. Pretransplantation donor pre-estimated glomerular filtration rate and hypertension did not show a significant area under the curve (AUC) for prediction of high tubular senescence. High plasma levels of soluble αKlotho were associated with a higher predictive value for low tubular cell senescence with an AUC of 0.78 (95% CI 0.62–0.93; p < 0.01). Conclusions: The nuclear p16-staining rate in donated kidney tubules is a predictor for allograft kidney function but not donor remnant kidney function. Detection of tubular cell senescence may facilitate selection of appropriate living donor candidates.

Increasing the Rate of Living Donor Kidney Transplantation in New Zealand: Developing an Evidence Base

2021 ◽  
Author(s):  
◽  
Paula Marie Martin
Keyword(s):  
Kidney Transplantation ◽  
New Zealand ◽  
Living Donor ◽  
Living Donation ◽  
Donor Kidney ◽  
Living Donor Kidney Transplantation ◽  
Living Donor Transplantation ◽  
End Stage ◽  
Donor Kidney Transplantation ◽  
Living Donor Kidney

<p>Increasing numbers of New Zealanders are experiencing end-stage renal failure, requiring kidney transplantation or dialysis. A transplant from a living kidney donor is the preferred treatment, offering better quality of life than dialysis, and greater life expectancy and cost-effectiveness than dialysis and deceased donor transplantation. Living donor transplant rates in New Zealand have plateaued and may even be declining at a time when many comparable countries are experiencing sustained increases. Viewing this issue as a complex policy problem, this research aimed to identify how rates of living donor kidney transplantation could be increased in New Zealand. Based on Walt and Gilson’s health policy triangle, which suggests that understanding policy issues requires attention not only to content (policy options) but also processes, contextual issues and actors, this research asked firstly, what the barriers are for patients in the journey to living donor transplantation, and secondly, why greater attention has not been paid to how to increase current rates, given evidence of better outcomes for patients and cost-effectiveness.  The research took a patient-centred, systems perspective and used a pragmatic, interdisciplinary, mixed-methods research design. Methods included a survey of kidney transplant waiting-list patients; interviews with patients, renal health professionals and key informants; document analysis; and a survey of health managers. A Five-Stage Model of the living donor kidney transplant process was developed to map specific barriers in the journey to transplantation and Kingdon’s multiple streams agenda-setting model was used to examine the issue of why so little attention had been paid to living donor kidney transplantation in New Zealand.  The research found that, in common with patients elsewhere, New Zealand patients are not systematically informed about living donor transplantation, would like to receive a transplant but have concerns about health and financial impacts on donors, and face challenges in approaching people in their networks about living donation. Incompatibility and medical unsuitability are major barriers for potential donors who do come forward. Issues with existing service models, configuration of key roles in transplant services, and delays in donor work-up processes are all evident. Perceived ethical constraints may limit how willing health professionals are to promote living donation, requiring both potential recipients and donors to be very proactive to successfully navigate the living donation process.  There has been political will to address organ shortages in the past but there has been little focus specifically on live donation. An absence of feasible and acceptable options for decision-makers to consider, crowding-out by demand for dialysis services, lack of leadership, absence of an effective advocate, and issues in funding and accountability arrangements may all have contributed to why live kidney transplantation has not had more prominence on the policy agenda in New Zealand in recent years.  Overall, the research concludes that policy and practice in the wider system are not adequately oriented to supporting living donor kidney transplantation as the preferred treatment for end-stage renal failure. A comprehensive national strategy for increasing New Zealand’s rate is recommended.</p>

scholarly journals Barriers to the Donation of Living Kidneys for Kidney Transplantation

2021 ◽  
Author(s):  
Kyungok Min ◽  
Tai Yeon Koo ◽  
Young Hui Hwang ◽  
Jaeseok Yang
Keyword(s):  
Kidney Transplantation ◽  
Living Donor ◽  
Kidney Donation ◽  
Living Kidney Donation ◽  
Donor Kidney ◽  
Related Factors ◽  
Living Donor Transplantation ◽  
Work Up ◽  
Donor Kidney Transplantation ◽  
Living Donor Kidney

Abstract Since the waiting time for deceased donor kidney transplantation continues to increase, living donor kidney transplantation is an important treatment for end stage kidney disease patients. Barriers to living kidney donation have been rarely investigated despite a growing interest in the utilization of living donor transplantation and the satisfaction of donor safety. Here, we retrospectively analyzed 1,658 potential donors and 1,273 potential recipients who visited the Seoul National University Hospital for living kidney transplantation between 2010 and 2017 to study the causes of donation failure. Among 1,658 potential donors, 902 (54.4%) failed to donate kidneys. The average number of potential donors that received work-up was 1.30 ± 0.66 per recipient. Among living donor kidney transplant patients, 75.1% received kidneys after work-up of the first donor and 24.9% needed work-up of two or more donors. Donor-related factors (49.2%) were the most common causes of donation failure, followed by immunologic or size mismatches between donors and recipients (25.4%) and recipient-related factors (16.2%). Interestingly, withdrawal of donation will along with refusal by recipients or family were the commonest causes, suggesting the importance of non-biomedical aspects. The elucidation of the barriers to living kidney donation could ensure more efficient and safer living kidney donation.

Increasing the Rate of Living Donor Kidney Transplantation in New Zealand: Developing an Evidence Base

2021 ◽  
Author(s):  
◽  
Paula Marie Martin
Keyword(s):  
Kidney Transplantation ◽  
New Zealand ◽  
Living Donor ◽  
Living Donation ◽  
Donor Kidney ◽  
Living Donor Kidney Transplantation ◽  
Living Donor Transplantation ◽  
End Stage ◽  
Donor Kidney Transplantation ◽  
Living Donor Kidney

<p>Increasing numbers of New Zealanders are experiencing end-stage renal failure, requiring kidney transplantation or dialysis. A transplant from a living kidney donor is the preferred treatment, offering better quality of life than dialysis, and greater life expectancy and cost-effectiveness than dialysis and deceased donor transplantation. Living donor transplant rates in New Zealand have plateaued and may even be declining at a time when many comparable countries are experiencing sustained increases. Viewing this issue as a complex policy problem, this research aimed to identify how rates of living donor kidney transplantation could be increased in New Zealand. Based on Walt and Gilson’s health policy triangle, which suggests that understanding policy issues requires attention not only to content (policy options) but also processes, contextual issues and actors, this research asked firstly, what the barriers are for patients in the journey to living donor transplantation, and secondly, why greater attention has not been paid to how to increase current rates, given evidence of better outcomes for patients and cost-effectiveness.  The research took a patient-centred, systems perspective and used a pragmatic, interdisciplinary, mixed-methods research design. Methods included a survey of kidney transplant waiting-list patients; interviews with patients, renal health professionals and key informants; document analysis; and a survey of health managers. A Five-Stage Model of the living donor kidney transplant process was developed to map specific barriers in the journey to transplantation and Kingdon’s multiple streams agenda-setting model was used to examine the issue of why so little attention had been paid to living donor kidney transplantation in New Zealand.  The research found that, in common with patients elsewhere, New Zealand patients are not systematically informed about living donor transplantation, would like to receive a transplant but have concerns about health and financial impacts on donors, and face challenges in approaching people in their networks about living donation. Incompatibility and medical unsuitability are major barriers for potential donors who do come forward. Issues with existing service models, configuration of key roles in transplant services, and delays in donor work-up processes are all evident. Perceived ethical constraints may limit how willing health professionals are to promote living donation, requiring both potential recipients and donors to be very proactive to successfully navigate the living donation process.  There has been political will to address organ shortages in the past but there has been little focus specifically on live donation. An absence of feasible and acceptable options for decision-makers to consider, crowding-out by demand for dialysis services, lack of leadership, absence of an effective advocate, and issues in funding and accountability arrangements may all have contributed to why live kidney transplantation has not had more prominence on the policy agenda in New Zealand in recent years.  Overall, the research concludes that policy and practice in the wider system are not adequately oriented to supporting living donor kidney transplantation as the preferred treatment for end-stage renal failure. A comprehensive national strategy for increasing New Zealand’s rate is recommended.</p>

Impact of ABO-Incompatible Living Donor Kidney Transplantation on Patient Survival

2020 ◽  
Vol 76 (5) ◽  
pp. 616-623 ◽  
Author(s):  
Allan B. Massie ◽  
Babak J. Orandi ◽  
Madeleine M. Waldram ◽  
Xun Luo ◽  
Anh Q. Nguyen ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Living Donor ◽  
Patient Survival ◽  
Donor Kidney ◽  
Living Donor Kidney Transplantation ◽  
Donor Kidney Transplantation ◽  
Living Donor Kidney
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