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Dual kidney

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By Adam Johnson General surgery resident. MD/MPH
Andrew S Levey, Lesley A Stevens, Christopher H Schmid, Yaping Lucy Zhang, Alejandro F Castro, Harold I Feldman, John W Kusek, Paul Eggers, Frederick Van Lente, Tom Greene, Josef Coresh
BACKGROUND: Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values. OBJECTIVE: To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. DESIGN: Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U...
May 5, 2009: Annals of Internal Medicine
Andrew S Levey, Lesley A Inker, Josef Coresh
Estimating glomerular filtration rate (GFR) is essential for clinical practice, research, and public health. Appropriate interpretation of estimated GFR (eGFR) requires understanding the principles of physiology, laboratory medicine, epidemiology, and biostatistics used in the development and validation of GFR estimating equations. Equations developed in diverse populations are less biased at higher GFRs than equations developed in chronic kidney disease (CKD) populations and are more appropriate for general use...
May 2014: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Kunihiro Matsushita, Bakhtawar K Mahmoodi, Mark Woodward, Jonathan R Emberson, Tazeen H Jafar, Sun Ha Jee, Kevan R Polkinghorne, Anoop Shankar, David H Smith, Marcello Tonelli, David G Warnock, Chi-Pang Wen, Josef Coresh, Ron T Gansevoort, Brenda R Hemmelgarn, Andrew S Levey
CONTEXT: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation more accurately estimates glomerular filtration rate (GFR) than the Modification of Diet in Renal Disease (MDRD) Study equation using the same variables, especially at higher GFR, but definitive evidence of its risk implications in diverse settings is lacking. OBJECTIVE: To evaluate risk implications of estimated GFR using the CKD-EPI equation compared with the MDRD Study equation in populations with a broad range of demographic and clinical characteristics...
May 9, 2012: JAMA: the Journal of the American Medical Association
B Tanriover, S Mohan, D J Cohen, J Radhakrishnan, T L Nickolas, P W Stone, D S Tsapepas, R J Crew, G K Dube, P R Sandoval, B Samstein, E Dogan, R S Gaston, J N Tanriover, L E Ratner, M A Hardy
Half of the recovered expanded criteria donor (ECD) kidneys are discarded in the United States. A new kidney allocation system offers kidneys at higher risk of discard, Kidney Donor Profile Index (KDPI)>85%, to a wider geographic area to promote broader sharing and expedite utilization. Dual kidney transplantation (DKT) based on the KDPI is a potential option to streamline allocation of kidneys which otherwise would have been discarded. To assess the clinical utility of the KDPI in kidneys at higher risk of discard, we analyzed the OPTN/UNOS Registry that included the deceased donor kidneys recovered between 2002 and 2012...
February 2014: American Journal of Transplantation
T Klair, A Gregg, J Phair, L K Kayler
UNOS guidelines provide inadequate discriminatory criteria for kidneys that should be transplanted as single (SKT) versus dual (DKT). We evaluated the utility of the kidney donor risk index (KDRI) to define kidneys with better outcomes when transplanted as dual. Using SRTR data from 1995 to 2010 of de novo KTX recipients of adult deceased-donor kidneys, we examined outcomes of SKT and DKT stratified by KDRI group ≤1.4 (n = 49 294), 1.41-1.8 (n = 15 674), 1.81-2.2 (n = 6523) and >2.2 (n = 2791). DKT of kidneys with KDRI >2...
September 2013: American Journal of Transplantation
S V Impedovo, E De Lorenzis, A Volpe, L Gesualdo, G Grandaliano, S Palazzo, G Lucarelli, C Bettocchi, C Terrone, P Stratta, M Quaglia, M Battaglia, P Ditonno
INTRODUCTION: Dual kidney transplantation (DKTx) to reduce the disparity between demand and supply of organs was evaluated in two Italian centers (Bari and Novara). MATERIALS AND METHODS: Between October 2000 and October 2011, we performed 97 DKT (26 ipsilateral/71 bilateral) following routine biopsy of all kidneys obtained from expanded criteria donors by Remuzzi-Karpinsky scores. The reference group was 379 single grafts from donors older than 60 years single kidney transplantation ([SKT] × > 60)...
April 2013: Transplantation Proceedings
M A Frutos, J J Mansilla, M Cabello, J Soler, P Ruiz, M Lebrón, V Baena, D Hernández
BACKGROUND: Cadaveric donation is now experiencing a trend toward the use of expanded criteria donors (ECD) who may not yield a suitable kidney for single organ transplantation which has occasionally led to their use as dual renal transplantations. MATERIAL AND METHODS: We undertook a case-control study to analyze our experiences between May 2007 and March 2011 with 80 kidneys from ECD who were older than 65 years. Of these, 40 were used as single transplants (STX) and the other 40 as dual cases (DTX)...
September 2012: Transplantation Proceedings
L Fernández-Lorente, L Riera, O Bestard, M Carrera, M Gomà, N Porta, J Torras, E Melilli, S Gil-Vernet, J M Grinyó, J M Cruzado
In our old-for-old program, we discard or allocate older extended criteria donor kidneys to single (SKT) or dual kidney transplantation (DKT) depending on histological Remuzzi's score in recipients older than 60 years. Here, we analyze the long-term results of this program and try to identify independent predictors of patient and graft survival. Between December 1996 and January 2008, we performed 115 SKT and 88 DKT. Discard rate was 15%. Acute rejection incidence was higher in SKT than in DKT (22.6% vs. 11...
October 2012: American Journal of Transplantation
K J Woodside, R M Merion, A B Leichtman, R de los Santos, C J Arrington, P S Rao, R S Sung
With the shortage of standard criteria donor (SCD) kidneys, efficient expanded criteria donor (ECD) kidney utilization has become more vital. We investigated the effects of the ECD label on kidney recovery, utilization and outcomes. Using data from the Scientific Registry of Transplant Recipients from November 2002 to May 2010, we determined recovery and transplant rates, and modeled discard risk, for kidneys within a range of kidney donor risk index (KDRI) 1.4-2.1 that included both SCD and ECD kidneys. To further compare similar quality kidneys, these kidneys were again divided into three KDRI intervals...
August 2012: American Journal of Transplantation
J M Cruzado, L Fernandez, L Riera, O Bestard, M Carrera, J Torras, S Gil Vernet, E Melilli, L Ngango, J M Grinyó
Double kidney transplantation is an accepted strategy to increase the donor pool. Regarding older donor kidneys, protocols for deciding to perform a dual or a single transplantation are mainly based on preimplantation biopsies. The aim of our study was to evaluate the long-term graft and patient survivals of our "Dual Kidney Transplant program." Patients who lost one of their grafts peritransplantation were used as controls. A total of 203 patients underwent kidney transplantation from December 1996 to January 2008 in our "old for old" renal transplantation program...
July 2011: Transplantation Proceedings
Cory M Hugen, Anthony J Polcari, Ronald Skolek, Martin F Mozes, John E Milner
PURPOSE: Dual kidney transplantation is a technique that some transplant centers have adopted to increase organ use. We investigated whether kidneys that were recovered and discarded were similar to those kidneys used for dual kidney transplantation. MATERIALS AND METHODS: We reviewed all kidneys recovered, biopsied and placed on machine perfusion in the state of Illinois from January 2002 to October 2009. We selected those kidneys used in dual kidney transplant, and compared their characteristics to those of kidneys that were recovered and biopsied but ultimately discarded...
September 2011: Journal of Urology
B Nardo, R Bertelli, G Cavallari, E Capocasale, G Cappelli, M P Mazzoni, L Benozzi, R Dalla Valle, G Fuga, N Busi, C Gilioli, A Albertazzi, S Stefoni, A D Pinna, A Faenza
INTRODUCTION: The use of kidneys from expanded criteria donors (ECD) is an attractive strategy to enlarge the pool of organs available for transplantation. Considering the fact that ECD organs have a reduced nephron mass, they are preferentially allocated for dual-kidney transplantation (DKT). Authors have reported excellent results of DKT when pretransplant ECD organs are evaluated for histological scores. The aim of this study was to evaluate DKT donor and recipient characteristics for comparison with DKT posttransplant outcomes versus those of recipients of single-kidney transplantations from expanded criteria (edSKT) and ideal donors (idSKT)...
June 2011: Transplantation Proceedings
M R Laftavi, R Stephan, L Feng, M Said, R Kohli, M Dayton, O Pankewycz
The disparity between donors and the demand for organ transplants grows steadily. Annually, 4700 patients die on the kidney transplant waiting list in the United States. To increase utilization of deceased donor organs, we expanded our acceptable criteria to include very old (VO) or very young (VY) donors. We transplanted both such kidneys (dual transplant) into a single recipient and evaluated the long-term outcomes and complications. From July 2001 to December 2005, 16 patients (mean age 68, range 60-78) received dual kidneys from VO (mean age 72, range 60-79) donors and 6 patients (mean age 47, range 27-72) were transplanted from VY (mean age 17 months, range 2-36) donors...
March 2011: Transplantation Proceedings
G Lucarelli, C Bettocchi, M Battaglia, S V Impedovo, A Vavallo, G Grandaliano, G Castellano, F P Schena, F P Selvaggi, P Ditonno
INTRODUCTION: Dual kidney transplantation (DKT), using extended criteria donor (ECD) grafts not suitable for single kidney transplantation (SKT), has been suggested to expand the kidney donor pool. Herein, we reviewed the long-term outcomes of DKT to assess its results versus a control group of 179 ECD SKTs. The allocation policy was based on a Remuzzi score obtained from a pretransplant biopsy. MATERIALS AND METHODS: We analyzed SKT in 179 (31.8%) and DKT in 41 (7...
May 2010: Transplantation Proceedings
Panduranga S Rao, Douglas E Schaubel, Mary K Guidinger, Kenneth A Andreoni, Robert A Wolfe, Robert M Merion, Friedrich K Port, Randall S Sung
BACKGROUND: We propose a continuous kidney donor risk index (KDRI) for deceased donor kidneys, combining donor and transplant variables to quantify graft failure risk. METHODS: By using national data from 1995 to 2005, we analyzed 69,440 first-time, kidney-only, deceased donor adult transplants. Cox regression was used to model the risk of death or graft loss, based on donor and transplant factors, adjusting for recipient factors. The proposed KDRI includes 14 donor and transplant factors, each found to be independently associated with graft failure or death: donor age, race, history of hypertension, history of diabetes, serum creatinine, cerebrovascular cause of death, height, weight, donation after cardiac death, hepatitis C virus status, human leukocyte antigen-B and DR mismatch, cold ischemia time, and double or en bloc transplant...
July 27, 2009: Transplantation
Phillip S Moore, Alan C Farney, Aimee K Sundberg, Michael S Rohr, Erica L Hartmann, Samy S Iskandar, Michael D Gautreaux, Jeffrey Rogers, William Doares, Teresa K Anderson, Patricia L Adams, Robert J Stratta
BACKGROUND: The purpose of this study was to perform a case-matched cohort analysis of dual kidney transplantation (DKT) from expanded criteria donors (ECDs) compared to single kidney transplantation (SKT) from concurrent ECDs and standard criteria donors (SCDs, defined as non-ECD). METHODS: Deceased donor (DD) kidney transplants (KTs) performed at a single center between October 2001 and February 2006 were reviewed retrospectively. If the calculated DD creatinine clearance (CrCl) was <65 mL/min, then the kidneys were transplanted dually into a single patient...
June 27, 2007: Transplantation
Phillip S Moore, Alan C Farney, Aimee K Sundberg, Michael S Rohr, Erica L Hartmann, Samy S Iskandar, Michael D Gautreaux, Jeffrey Rogers, William Doares, Teresa K Anderson, Patricia L Adams, Robert J Stratta
BACKGROUND: Dual kidney transplantation (DKT) from donors at the extremes of age represents one approach to expanding the organ donor pool. The purpose of this study was to review our experience with DKT from older donors and en bloc KT (EBKT) from small pediatric donors. METHODS: Deceased donor KTs performed at our center between October 2001 and November 2005, were reviewed retrospectively. If the calculated creatinine clearance in an expanded criteria donor was <65 mL/min, then the kidneys were transplanted dually into a single adult recipient...
October 2006: Surgery
P Ruggenenti, N Perico, G Remuzzi
Using kidneys from expanded criteria donors (ECD) increased transplant activity but resulted in a reduced graft survival. The relatively poor long-term outcome of ECD grafts may be the consequence of an imbalance between the number of viable nephrons supplied and the metabolic demand of the recipient. Providing more nephrons by dual transplants may improve outcomes but fails, per se, to confer the same benefit of single transplants from young donors. A biopsy-based score system has been presented by a panel of pathologists to assess whether kidneys from donors older than 60 years still contain enough viable nephrons to be made available for transplantation, and whether single or dual transplantation should be used...
November 2006: American Journal of Transplantation
Giuseppe Remuzzi, Paolo Cravedi, Annalisa Perna, Borislav D Dimitrov, Marta Turturro, Giuseppe Locatelli, Paolo Rigotti, Nicola Baldan, Marco Beatini, Umberto Valente, Mario Scalamogna, Piero Ruggenenti
BACKGROUND: Long-term survival of kidney grafts from older donors is inferior to that of grafts from younger donors. We sought to determine whether selecting older kidneys according to their histologic characteristics before implantation would positively influence long-term outcome. METHODS: In a prospective cohort study, we assessed outcomes among 62 patients who received one or two histologically evaluated kidneys from donors older than 60 years of age. These outcomes were compared with outcomes among 248 matched recipients of single kidney grafts that had not been histologically evaluated and were either from donors 60 years of age or younger (124 positive-reference recipients who, according to available data, were expected to have an optimal outcome) or from those older than 60 years (124 negative-reference recipients, expected to have a worse outcome)...
January 26, 2006: New England Journal of Medicine
A Faenza, E Sestigliani, L Zambianchi, L Ridolfi
In recent years over 30% of cadaver donors utilized in the Emilia Romagna (ER) region are over 60 years of age often with some additional risk factors. The organs of these Suboptimal Kidney Donors (SOKD) had been seldomly accepted from 1996 to 1999 (Group 1). From 2000, marking the beginning of use of double transplantation for marginal kidneys, a routine biopsy was performed for SOKD using the Score System proposed by Remuzzi. (Group 2) The 40% of marginal kidneys harvested were utilize in 76% of cases. The few biopsies available for Group 1 patients testify that good kidneys had been discarded, but even in Group 2, when we followed the biopsy Score, strictly several mistakes were suspected: kidneys discarded for an unbelievable difference of 2 points between two kidneys of the same size, cases with an high score based on only a few glomeruli, double kidney transplants that become single and still had fair functions...
April 2004: Transplantation Proceedings
2014-02-10 15:13:59
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