دورية أكاديمية
A nationwide evaluation of deceased donor kidney transplantation indicates detrimental consequences of early graft loss.
| العنوان: | A nationwide evaluation of deceased donor kidney transplantation indicates detrimental consequences of early graft loss. |
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| المؤلفون: | de Kok MJ; Department of Surgery and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands., Schaapherder AF; Department of Surgery and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands., Mensink JW; Department of Surgery and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands; Dutch Transplant Foundation, Leiden, The Netherlands., de Vries AP; Department of Internal Medicine (Nephrology) and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands., Reinders ME; Department of Internal Medicine (Nephrology) and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands., Konijn C; Dutch Transplant Foundation, Leiden, The Netherlands., Bemelman FJ; Department of Internal Medicine (Nephrology), Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands., van de Wetering J; Department of Internal Medicine (Nephrology), Erasmus University Medical Center, Rotterdam, The Netherlands., van Zuilen AD; Department of Internal Medicine (Nephrology), University Medical Center Utrecht, Utrecht, The Netherlands., Christiaans MH; Department of Internal Medicine (Nephrology), Maastricht University Medical Center, Maastricht, The Netherlands., Baas MC; Department of Internal Medicine (Nephrology), Radboud University Medical Center, Nijmegen, The Netherlands., Nurmohamed AS; Department of Internal Medicine (Nephrology), Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands., Berger SP; Department of Internal Medicine (Nephrology), University Medical Center Groningen, Groningen, The Netherlands., Ploeg RJ; Department of Surgery and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom., Alwayn IP; Department of Surgery and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands., Lindeman JH; Department of Surgery and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: lindeman@lumc.nl. |
| المصدر: | Kidney international [Kidney Int] 2020 Jun; Vol. 97 (6), pp. 1243-1252. Date of Electronic Publication: 2020 Feb 29. |
| نوع المنشور: | Journal Article; Observational Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 0323470 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1523-1755 (Electronic) Linking ISSN: 00852538 NLM ISO Abbreviation: Kidney Int Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2016- : New York : Elsevier Original Publication: New York, Springer-Verlag. |
| مواضيع طبية MeSH: | Kidney Transplantation*/adverse effects, Graft Rejection/epidemiology ; Graft Survival ; Humans ; Kidney ; Netherlands/epidemiology ; Retrospective Studies ; Tissue Donors ; Treatment Outcome |
| مستخلص: | Early graft loss (EGL) is a feared outcome of kidney transplantation. Consequently, kidneys with an anticipated risk of EGL are declined for transplantation. In the most favorable scenario, with optimal use of available donor kidneys, the donor pool size is balanced by the risk of EGL, with a tradeoff dictated by the consequences of EGL. To gauge the consequence of EGL we systematically evaluated its impact in an observational study that included all 10,307 deceased-donor kidney transplantations performed in The Netherlands between 1990 and 2018. Incidence of EGL, defined as graft loss within 90 days, in primary transplantation was 8.2% (699/8,511). The main causes were graft rejection (30%), primary nonfunction (25%), and thrombosis or infarction (20%). EGL profoundly impacted short- and long-term patient survival (adjusted hazard ratio; 95% confidence interval: 8.2; 5.1-13.2 and 1.7; 1.3-2.1, respectively). Of the EGL recipients who survived 90 days after transplantation (617/699) only 440 of the 617 were relisted for re-transplantation. Of those relisted, only 298 were ultimately re-transplanted leading to an actual re-transplantation rate of 43%. Noticeably, re-transplantation was associated with a doubled incidence of EGL, but similar long-term graft survival (adjusted hazard ratio 1.1; 0.6-1.8). Thus, EGL after kidney transplantation is a medical catastrophe with high mortality rates, low relisting rates, and increased risk of recurrent EGL following re-transplantation. This implies that detrimental outcomes also involve convergence of risk factors in recipients with EGL. The 8.2% incidence of EGL minimally impacted population mortality, indicating this incidence is acceptable. (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: deceased-donor kidney transplantation; early graft loss; graft survival; patient survival; primary nonfunction; re-transplantation |
| تواريخ الأحداث: | Date Created: 20200504 Date Completed: 20210621 Latest Revision: 20210621 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1016/j.kint.2020.01.043 |
| PMID: | 32359810 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1523-1755 |
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| DOI: | 10.1016/j.kint.2020.01.043 |