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ECD Kidneys (ecd + kidney)

Distribution by Scientific Domains
Medical Sciences100%

Selected Abstracts

Allocation of ECD Kidneys Based on Donor GFR: The Choice of the Estimating Equation Matters

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010
P. Delanaye
No abstract is available for this article. [source]

Donor-Estimated GFR as an Appropriate Criterion for Allocation of ECD Kidneys into Single or Dual Kidney Transplantation

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 11 2009
R. Snanoudj
It has been suggested that dual kidney transplantation (DKT) improves outcomes for expanded criteria donor (ECD) kidneys. However, no criteria for allocation to single or dual transplantation have been assessed prospectively. The strategy of DKT remains underused and potentially eligible kidneys are frequently discarded. We prospectively compared 81 DKT and 70 single kidney transplant (SKT) receiving grafts from ECD donors aged >65 years, allocated according to donor estimated glomerular filtration rate (eGFR): DKT if eGFR between 30 and 60 mL/min, SKT if eGFR greater than 60 mL/min. Patient and graft survival were similar in the two groups. In the DKT group, 13/81 patients lost one of their two kidneys due to hemorrhage, arterial or venous thrombosis. Mean eGFR at month 12 was similar in the DKT and SKT groups (47.8 mL/min and 46.4 mL/min, respectively). Simulated allocation of kidneys according to criteria based on day 0 donor parameters such as those described by Remuzzi et al., Andres et al. and UNOS, did not indicate an improvement in 12-month eGFR compared to our allocation based on donor eGFR. [source]

Editorial: The ,Two, One, Zero' Decision: What to Do with Suboptimal Deceased Donor Kidneys

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010
R. Shapiro
While it is feasible to transplant two ECD kidneys into a single recipient, we need better data to help us decide with confidence whether a given set of kidneys should be transplanted into two patients, one patient, or not at all. See article by Esker et al on page 2000. [source]

The Expanded Criteria Donor Policy: An Evaluation of Program Objectives and Indirect Ramifications

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2006
J. D. Schold
The expanded criteria donor (ECD) policy was formalized in 2002, which defined higher-risk deceased donor kidneys recovered for transplantation. There has not been a comprehensive examination of the impact of policy on the allocation of ECD kidneys, waiting times for transplant, center listing patterns or human leukocyte antigen (HLA) matching. We examined transplant candidates from 1998 to 2004 utilizing a national database. We constructed models to assess alterations in recipient characteristics of ECD kidneys and trends in waiting time and cold ischemia time (CIT) associated with policy. We also evaluated the impact of the proportion of center candidate listings for ECD kidneys on waiting times. Elderly recipients were more likely to receive ECDs following policy (odds ratio = 1.36, p < 0.01). There was no association of decreased CIT or pretransplant dialysis time while increasing HLA mismatching with policy inception. Over one quarter of centers listed <20% of candidates for ECDs, while an additional quarter of centers listed >90%. Only centers with selective listing for ECDs offered reduced waiting times to ECD recipients. The ECD policy demonstrates potential to achieve certain ascribed goals; however, the full impact of the program, reaching all transplant candidates, may only be achieved once ECD listing patterns are recommended and adopted accordingly. [source]

Immunosuppression without calcineurin inhibition: optimization of renal function in expanded criteria donor renal transplantation

CLINICAL TRANSPLANTATION, Issue 1 2009
Patrick P.W. Luke
Abstract:, Introduction:, To assess the efficacy of calcineurin inhibitor (CNI)-free immunosuppression vs. calcineurin-based immunosuppression in patients receiving expanded criteria donor (ECD) kidneys. Patient and methods:, Thirteen recipients of ECD kidneys were enrolled in this pilot study and treated with induction therapy and maintained on sirolimus, mycophenolate mofetil (MMF) and prednisone. A contemporaneous control group was randomly selected comprised of 13 recipients of ECD kidneys who had been maintained on CNI plus MMF and prednisone. Results:, For the study group vs. the control group, two-yr graft survival was 92.3% vs. 84.6% (p = NS), two-yr patient survival was 100% vs. 92.3% (p = NS) and the acute rejection rates were 23% vs. 31% (p = NS), respectively. Renal function was significantly better in the study group compared with control up to the six-month mark, after which, it remained numerically but not statistically significant. Complications were more common in the study group, but serious adverse events requiring discontinuation were rare. Conclusion:, This pilot study demonstrates that CNI-free regimens can be safely implemented in patients receiving ECD kidneys with excellent two-yr patient and graft survival and good renal allograft function. Longer follow-up in larger randomized controlled trials are necessary to establish these findings. [source]