Cargando…
Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study
Objectives To assess the long term outcomes of transplantation using expanded criteria donors (ECD; donors aged ≥60 years or aged 50-59 years with vascular comorbidities) and assess the main determinants of its prognosis. Design Prospective, population based cohort study. Setting Four French referra...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group Ltd.
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521904/ https://www.ncbi.nlm.nih.gov/pubmed/26232393 http://dx.doi.org/10.1136/bmj.h3557 |
_version_ | 1782383881341632512 |
---|---|
author | Aubert, Olivier Kamar, Nassim Vernerey, Dewi Viglietti, Denis Martinez, Frank Duong-Van-Huyen, Jean-Paul Eladari, Dominique Empana, Jean-Philippe Rabant, Marion Verine, Jerome Rostaing, Lionel Congy, Nicolas Guilbeau-Frugier, Céline Mourad, Georges Garrigue, Valérie Morelon, Emmanuel Giral, Magali Kessler, Michèle Ladrière, Marc Delahousse, Michel Glotz, Denis Legendre, Christophe Jouven, Xavier Lefaucheur, Carmen Loupy, Alexandre |
author_facet | Aubert, Olivier Kamar, Nassim Vernerey, Dewi Viglietti, Denis Martinez, Frank Duong-Van-Huyen, Jean-Paul Eladari, Dominique Empana, Jean-Philippe Rabant, Marion Verine, Jerome Rostaing, Lionel Congy, Nicolas Guilbeau-Frugier, Céline Mourad, Georges Garrigue, Valérie Morelon, Emmanuel Giral, Magali Kessler, Michèle Ladrière, Marc Delahousse, Michel Glotz, Denis Legendre, Christophe Jouven, Xavier Lefaucheur, Carmen Loupy, Alexandre |
author_sort | Aubert, Olivier |
collection | PubMed |
description | Objectives To assess the long term outcomes of transplantation using expanded criteria donors (ECD; donors aged ≥60 years or aged 50-59 years with vascular comorbidities) and assess the main determinants of its prognosis. Design Prospective, population based cohort study. Setting Four French referral centres. Participants Consecutive patients who underwent kidney transplantation between January 2004 and January 2011, and were followed up to May 2014. A validation cohort included patients from another four referral centres in France who underwent kidney transplantation between January 2002 and December 2011. Main outcome measures Long term kidney allograft survival, based on systematic assessment of donor, recipient, and transplant clinical characteristics; preimplantation biopsy; and circulating levels of donor specific anti-HLA (human leucocyte antigen) antibody (DSA) at baseline. Results The study included 6891 patients (2763 in the principal cohort, 4128 in the validation cohort). Of 2763 transplantations performed, 916 (33.2%) used ECD kidneys. Overall, patients receiving ECD transplants had lower allograft survival after seven years than patients receiving transplants from standard criteria donors (SCD; 80% v 88%, P<0.001). Patients receiving ECD transplants who presented with circulating DSA at the time of transplantation had worse allograft survival after seven years than patients receiving ECD kidneys without circulating DSA at transplantation (44% v 85%, P<0.001). After adjusting for donor, recipient, and transplant characteristics, as well as preimplantation biopsy findings and baseline immunological parameters, the main independent determinants of long term allograft loss were identified as allocation of ECDs (hazard ratio 1.84 (95% confidence interval 1.5 to 2.3); P<0.001), presence of circulating DSA on the day of transplantation (3.00 (2.3 to 3.9); P<0.001), and longer cold ischaemia time (>12 h; 1.53 (1.1 to 2.1); P=0.011). Recipients of ECD kidneys with circulating DSA showed a 5.6-fold increased risk of graft loss compared with all other transplant therapies (P<0.001). ECD allograft survival at seven years significantly improved with screening and transplantation in the absence of circulating DSA (P<0.001) and with shorter (<12 h) cold ischaemia time (P=0.030), respectively. This strategy achieved ECD graft survival comparable to that of patients receiving an SCD transplant overall, translating to a 544.6 allograft life years saved during the nine years of study inclusion time. Conclusions Circulating DSA and cold ischaemia time are the main independent determinants of outcome from ECD transplantation. Allocation policies to avoid DSA and reduction of cold ischaemia time to increase efficacy could promote wider implement of ECD transplantation in the context of organ shortage and improve its prognosis. |
format | Online Article Text |
id | pubmed-4521904 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BMJ Publishing Group Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-45219042015-08-03 Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study Aubert, Olivier Kamar, Nassim Vernerey, Dewi Viglietti, Denis Martinez, Frank Duong-Van-Huyen, Jean-Paul Eladari, Dominique Empana, Jean-Philippe Rabant, Marion Verine, Jerome Rostaing, Lionel Congy, Nicolas Guilbeau-Frugier, Céline Mourad, Georges Garrigue, Valérie Morelon, Emmanuel Giral, Magali Kessler, Michèle Ladrière, Marc Delahousse, Michel Glotz, Denis Legendre, Christophe Jouven, Xavier Lefaucheur, Carmen Loupy, Alexandre BMJ Research Objectives To assess the long term outcomes of transplantation using expanded criteria donors (ECD; donors aged ≥60 years or aged 50-59 years with vascular comorbidities) and assess the main determinants of its prognosis. Design Prospective, population based cohort study. Setting Four French referral centres. Participants Consecutive patients who underwent kidney transplantation between January 2004 and January 2011, and were followed up to May 2014. A validation cohort included patients from another four referral centres in France who underwent kidney transplantation between January 2002 and December 2011. Main outcome measures Long term kidney allograft survival, based on systematic assessment of donor, recipient, and transplant clinical characteristics; preimplantation biopsy; and circulating levels of donor specific anti-HLA (human leucocyte antigen) antibody (DSA) at baseline. Results The study included 6891 patients (2763 in the principal cohort, 4128 in the validation cohort). Of 2763 transplantations performed, 916 (33.2%) used ECD kidneys. Overall, patients receiving ECD transplants had lower allograft survival after seven years than patients receiving transplants from standard criteria donors (SCD; 80% v 88%, P<0.001). Patients receiving ECD transplants who presented with circulating DSA at the time of transplantation had worse allograft survival after seven years than patients receiving ECD kidneys without circulating DSA at transplantation (44% v 85%, P<0.001). After adjusting for donor, recipient, and transplant characteristics, as well as preimplantation biopsy findings and baseline immunological parameters, the main independent determinants of long term allograft loss were identified as allocation of ECDs (hazard ratio 1.84 (95% confidence interval 1.5 to 2.3); P<0.001), presence of circulating DSA on the day of transplantation (3.00 (2.3 to 3.9); P<0.001), and longer cold ischaemia time (>12 h; 1.53 (1.1 to 2.1); P=0.011). Recipients of ECD kidneys with circulating DSA showed a 5.6-fold increased risk of graft loss compared with all other transplant therapies (P<0.001). ECD allograft survival at seven years significantly improved with screening and transplantation in the absence of circulating DSA (P<0.001) and with shorter (<12 h) cold ischaemia time (P=0.030), respectively. This strategy achieved ECD graft survival comparable to that of patients receiving an SCD transplant overall, translating to a 544.6 allograft life years saved during the nine years of study inclusion time. Conclusions Circulating DSA and cold ischaemia time are the main independent determinants of outcome from ECD transplantation. Allocation policies to avoid DSA and reduction of cold ischaemia time to increase efficacy could promote wider implement of ECD transplantation in the context of organ shortage and improve its prognosis. BMJ Publishing Group Ltd. 2015-07-31 /pmc/articles/PMC4521904/ /pubmed/26232393 http://dx.doi.org/10.1136/bmj.h3557 Text en © Aubert et al 2015 http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Research Aubert, Olivier Kamar, Nassim Vernerey, Dewi Viglietti, Denis Martinez, Frank Duong-Van-Huyen, Jean-Paul Eladari, Dominique Empana, Jean-Philippe Rabant, Marion Verine, Jerome Rostaing, Lionel Congy, Nicolas Guilbeau-Frugier, Céline Mourad, Georges Garrigue, Valérie Morelon, Emmanuel Giral, Magali Kessler, Michèle Ladrière, Marc Delahousse, Michel Glotz, Denis Legendre, Christophe Jouven, Xavier Lefaucheur, Carmen Loupy, Alexandre Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study |
title | Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study |
title_full | Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study |
title_fullStr | Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study |
title_full_unstemmed | Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study |
title_short | Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study |
title_sort | long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521904/ https://www.ncbi.nlm.nih.gov/pubmed/26232393 http://dx.doi.org/10.1136/bmj.h3557 |
work_keys_str_mv | AT aubertolivier longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT kamarnassim longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT vernereydewi longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT vigliettidenis longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT martinezfrank longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT duongvanhuyenjeanpaul longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT eladaridominique longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT empanajeanphilippe longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT rabantmarion longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT verinejerome longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT rostainglionel longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT congynicolas longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT guilbeaufrugierceline longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT mouradgeorges longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT garriguevalerie longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT morelonemmanuel longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT giralmagali longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT kesslermichele longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT ladrieremarc longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT delahoussemichel longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT glotzdenis longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT legendrechristophe longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT jouvenxavier longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT lefaucheurcarmen longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy AT loupyalexandre longtermoutcomesoftransplantationusingkidneysfromexpandedcriteriadonorsprospectivepopulationbasedcohortstudy |