Characteristics and performance of unilateral kidney transplants from deceased donors

Syed Ali Husain, Mariana C. Chiles, Samnang Lee, Stephen O. Pastan, Rachel E. Patzer, Bekir Tanriover, Lloyd E. Ratner, Sumit Mohan

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background and objectives The fraction of kidneys procured for transplant that are discarded is rising in the United States. Identifying donors from whom only one kidney was discarded allows us to control for donor traits and better assess reasons for organ discard. Design, setting, participants, & measurements We conducted a retrospective cohort study using United Network for Organ Sharing Standard Transplant Analysis and Research file data to identify deceased donors from whom two kidneys were procured and at least one was transplanted. Unilateral pairs were defined as kidney pairs from a single donor from whom one kidney was discarded (“unilateral discard”) but the other was transplanted (“unilateral transplant”). Organ quality was estimated using the Kidney Donor Risk Index and Kidney Donor Profile Index (KDPI). We compared all-cause graft failure rates for unilateral transplants to those for bilateral transplant Kaplan-Meier methods, and life table methodology was used to evaluate 1-, 2-, 3-, and 5-year survival rates of transplants from bilateral and unilateral donors. Results Compared with bilateral donors (i.e., both kidneys transplanted) (n=80,584), unilateral donors (i.e., only one kidney transplanted) (n=7625) had higher mean terminal creatinine (1.3±2.1 mg/dl versus 1.160.9 mg/dl) and KDPI (67%±25% versus 42%±27%), were older, and were more likely to have hypertension, diabetes, hepatitis C, terminal stroke, or meet Centers for Disease Control and Prevention high-risk donor criteria. Unilateral discards were primarily attributed to factors expected to be similar in both kidneys from a donor: biopsy findings (22%), no interested recipient (13%), and donor history (7%).Anatomic abnormalities (14%), organ damage (11%), and extended ischemia (6%) accounted for about 30% of discards, but were the commonest reasons among low KDPI kidneys. Among kidneys with KDPI≥60%, there was an incremental difference in allograft survival over time (for unilateral versus bilateral transplants, 1-year survival: 83%versus 87%; 3-year survival: 69%versus 73%; 5-year survival: 51% versus 58%). Conclusions A large number of discarded kidneys were procured from donors whose contralateral kidneys were transplanted with good post-transplant outcomes.

Original languageEnglish (US)
Pages (from-to)118-127
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume13
Issue number1
DOIs
StatePublished - Jan 6 2018

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Transplants
Kidney
Life Tables
Information Storage and Retrieval
Centers for Disease Control and Prevention (U.S.)
Hepatitis C
Allografts
Creatinine
Cohort Studies
Ischemia
Survival Rate
Retrospective Studies
Stroke
Hypertension
Biopsy

Keywords

  • Allografts
  • Biopsy
  • Cadaver organ transplantation
  • Centers for disease control and prevention (U.S.)
  • Clinical epidemiology
  • Creatinine
  • Death
  • Diabetes mellitus
  • Hepatitis C
  • Hypertension
  • Kidney
  • Kidney transplantation
  • Life tables
  • Retrospective studies
  • Stroke
  • Survival rate
  • Tissue donors
  • Transplant outcomes
  • United States

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Characteristics and performance of unilateral kidney transplants from deceased donors. / Husain, Syed Ali; Chiles, Mariana C.; Lee, Samnang; Pastan, Stephen O.; Patzer, Rachel E.; Tanriover, Bekir; Ratner, Lloyd E.; Mohan, Sumit.

In: Clinical Journal of the American Society of Nephrology, Vol. 13, No. 1, 06.01.2018, p. 118-127.

Research output: Contribution to journalArticle

Husain, Syed Ali ; Chiles, Mariana C. ; Lee, Samnang ; Pastan, Stephen O. ; Patzer, Rachel E. ; Tanriover, Bekir ; Ratner, Lloyd E. ; Mohan, Sumit. / Characteristics and performance of unilateral kidney transplants from deceased donors. In: Clinical Journal of the American Society of Nephrology. 2018 ; Vol. 13, No. 1. pp. 118-127.
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abstract = "Background and objectives The fraction of kidneys procured for transplant that are discarded is rising in the United States. Identifying donors from whom only one kidney was discarded allows us to control for donor traits and better assess reasons for organ discard. Design, setting, participants, & measurements We conducted a retrospective cohort study using United Network for Organ Sharing Standard Transplant Analysis and Research file data to identify deceased donors from whom two kidneys were procured and at least one was transplanted. Unilateral pairs were defined as kidney pairs from a single donor from whom one kidney was discarded (“unilateral discard”) but the other was transplanted (“unilateral transplant”). Organ quality was estimated using the Kidney Donor Risk Index and Kidney Donor Profile Index (KDPI). We compared all-cause graft failure rates for unilateral transplants to those for bilateral transplant Kaplan-Meier methods, and life table methodology was used to evaluate 1-, 2-, 3-, and 5-year survival rates of transplants from bilateral and unilateral donors. Results Compared with bilateral donors (i.e., both kidneys transplanted) (n=80,584), unilateral donors (i.e., only one kidney transplanted) (n=7625) had higher mean terminal creatinine (1.3±2.1 mg/dl versus 1.160.9 mg/dl) and KDPI (67{\%}±25{\%} versus 42{\%}±27{\%}), were older, and were more likely to have hypertension, diabetes, hepatitis C, terminal stroke, or meet Centers for Disease Control and Prevention high-risk donor criteria. Unilateral discards were primarily attributed to factors expected to be similar in both kidneys from a donor: biopsy findings (22{\%}), no interested recipient (13{\%}), and donor history (7{\%}).Anatomic abnormalities (14{\%}), organ damage (11{\%}), and extended ischemia (6{\%}) accounted for about 30{\%} of discards, but were the commonest reasons among low KDPI kidneys. Among kidneys with KDPI≥60{\%}, there was an incremental difference in allograft survival over time (for unilateral versus bilateral transplants, 1-year survival: 83{\%}versus 87{\%}; 3-year survival: 69{\%}versus 73{\%}; 5-year survival: 51{\%} versus 58{\%}). Conclusions A large number of discarded kidneys were procured from donors whose contralateral kidneys were transplanted with good post-transplant outcomes.",
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T1 - Characteristics and performance of unilateral kidney transplants from deceased donors

AU - Husain, Syed Ali

AU - Chiles, Mariana C.

AU - Lee, Samnang

AU - Pastan, Stephen O.

AU - Patzer, Rachel E.

AU - Tanriover, Bekir

AU - Ratner, Lloyd E.

AU - Mohan, Sumit

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N2 - Background and objectives The fraction of kidneys procured for transplant that are discarded is rising in the United States. Identifying donors from whom only one kidney was discarded allows us to control for donor traits and better assess reasons for organ discard. Design, setting, participants, & measurements We conducted a retrospective cohort study using United Network for Organ Sharing Standard Transplant Analysis and Research file data to identify deceased donors from whom two kidneys were procured and at least one was transplanted. Unilateral pairs were defined as kidney pairs from a single donor from whom one kidney was discarded (“unilateral discard”) but the other was transplanted (“unilateral transplant”). Organ quality was estimated using the Kidney Donor Risk Index and Kidney Donor Profile Index (KDPI). We compared all-cause graft failure rates for unilateral transplants to those for bilateral transplant Kaplan-Meier methods, and life table methodology was used to evaluate 1-, 2-, 3-, and 5-year survival rates of transplants from bilateral and unilateral donors. Results Compared with bilateral donors (i.e., both kidneys transplanted) (n=80,584), unilateral donors (i.e., only one kidney transplanted) (n=7625) had higher mean terminal creatinine (1.3±2.1 mg/dl versus 1.160.9 mg/dl) and KDPI (67%±25% versus 42%±27%), were older, and were more likely to have hypertension, diabetes, hepatitis C, terminal stroke, or meet Centers for Disease Control and Prevention high-risk donor criteria. Unilateral discards were primarily attributed to factors expected to be similar in both kidneys from a donor: biopsy findings (22%), no interested recipient (13%), and donor history (7%).Anatomic abnormalities (14%), organ damage (11%), and extended ischemia (6%) accounted for about 30% of discards, but were the commonest reasons among low KDPI kidneys. Among kidneys with KDPI≥60%, there was an incremental difference in allograft survival over time (for unilateral versus bilateral transplants, 1-year survival: 83%versus 87%; 3-year survival: 69%versus 73%; 5-year survival: 51% versus 58%). Conclusions A large number of discarded kidneys were procured from donors whose contralateral kidneys were transplanted with good post-transplant outcomes.

AB - Background and objectives The fraction of kidneys procured for transplant that are discarded is rising in the United States. Identifying donors from whom only one kidney was discarded allows us to control for donor traits and better assess reasons for organ discard. Design, setting, participants, & measurements We conducted a retrospective cohort study using United Network for Organ Sharing Standard Transplant Analysis and Research file data to identify deceased donors from whom two kidneys were procured and at least one was transplanted. Unilateral pairs were defined as kidney pairs from a single donor from whom one kidney was discarded (“unilateral discard”) but the other was transplanted (“unilateral transplant”). Organ quality was estimated using the Kidney Donor Risk Index and Kidney Donor Profile Index (KDPI). We compared all-cause graft failure rates for unilateral transplants to those for bilateral transplant Kaplan-Meier methods, and life table methodology was used to evaluate 1-, 2-, 3-, and 5-year survival rates of transplants from bilateral and unilateral donors. Results Compared with bilateral donors (i.e., both kidneys transplanted) (n=80,584), unilateral donors (i.e., only one kidney transplanted) (n=7625) had higher mean terminal creatinine (1.3±2.1 mg/dl versus 1.160.9 mg/dl) and KDPI (67%±25% versus 42%±27%), were older, and were more likely to have hypertension, diabetes, hepatitis C, terminal stroke, or meet Centers for Disease Control and Prevention high-risk donor criteria. Unilateral discards were primarily attributed to factors expected to be similar in both kidneys from a donor: biopsy findings (22%), no interested recipient (13%), and donor history (7%).Anatomic abnormalities (14%), organ damage (11%), and extended ischemia (6%) accounted for about 30% of discards, but were the commonest reasons among low KDPI kidneys. Among kidneys with KDPI≥60%, there was an incremental difference in allograft survival over time (for unilateral versus bilateral transplants, 1-year survival: 83%versus 87%; 3-year survival: 69%versus 73%; 5-year survival: 51% versus 58%). Conclusions A large number of discarded kidneys were procured from donors whose contralateral kidneys were transplanted with good post-transplant outcomes.

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KW - Biopsy

KW - Cadaver organ transplantation

KW - Centers for disease control and prevention (U.S.)

KW - Clinical epidemiology

KW - Creatinine

KW - Death

KW - Diabetes mellitus

KW - Hepatitis C

KW - Hypertension

KW - Kidney

KW - Kidney transplantation

KW - Life tables

KW - Retrospective studies

KW - Stroke

KW - Survival rate

KW - Tissue donors

KW - Transplant outcomes

KW - United States

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