Combined predictive value of the expanded donor criteria for long-term graft survival of kidneys from donors after cardiac death

A single-center experience over three decades

Mamoru Kusaka, Yusuke Kubota, Hitomi Sasaki, Naohiko Fukami, Tamio Fujita, Yuichi Hirose, Hiroshi Takahashi, Takashi Kenmochi, Ryoichi Shiroki, Kiyotaka Hoshinaga

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: Kidneys procured from the deceased hold great potential for expanding the donor pool. The aims of the present study were to investigate the post-transplant outcomes of renal allografts recovered from donors after cardiac death, to identify risk factors affecting the renal prognosis and to compare the long-term survival from donors after cardiac death according to the number of risk factors shown by expanded criteria donors. Methods: A total of 443 grafts recovered using an in situ regional cooling technique from 1983 to 2011 were assessed. To assess the combined predictive value of the significant expanded criteria donor risk criteria, the patients were divided into three groups: those with no expanded criteria donor risk factors (no risk), one expanded criteria donor risk factor (single-risk) and two or more expanded criteria donor risk factors (multiple-risk). Results: Among the donor factors, age ≥50 years, hypertension, maximum serum creatinine level ≥1.5 mg/dL and a warm ischemia time ≥30 min were identified as independent predictors of long-term graft failure on multivariate analysis. Regarding the expanded criteria donors criteria for marginal donors, cerebrovascular disease, hypertension and maximum serum creatinine level ≥1.5 mg/dL were identified as significant predictors on univariate analysis. The single- and multiple-risk groups showed 2.01- and 2.40-fold higher risks of graft loss, respectively. Conclusions: Renal grafts recovered from donors after cardiac death donors have a good renal function with an excellent long-term graft survival. However, an increased number of expanded criteria donors risk factors increase the risk of graft loss.

Original languageEnglish
Pages (from-to)319-324
Number of pages6
JournalInternational Journal of Urology
Volume23
Issue number4
DOIs
Publication statusPublished - 01-04-2016

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Graft Survival
Tissue Donors
Kidney
Transplants
Creatinine
Hypertension
Cerebrovascular Disorders
Warm Ischemia
Age Factors
Serum
Allografts
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Kusaka, Mamoru ; Kubota, Yusuke ; Sasaki, Hitomi ; Fukami, Naohiko ; Fujita, Tamio ; Hirose, Yuichi ; Takahashi, Hiroshi ; Kenmochi, Takashi ; Shiroki, Ryoichi ; Hoshinaga, Kiyotaka. / Combined predictive value of the expanded donor criteria for long-term graft survival of kidneys from donors after cardiac death : A single-center experience over three decades. In: International Journal of Urology. 2016 ; Vol. 23, No. 4. pp. 319-324.
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abstract = "Objectives: Kidneys procured from the deceased hold great potential for expanding the donor pool. The aims of the present study were to investigate the post-transplant outcomes of renal allografts recovered from donors after cardiac death, to identify risk factors affecting the renal prognosis and to compare the long-term survival from donors after cardiac death according to the number of risk factors shown by expanded criteria donors. Methods: A total of 443 grafts recovered using an in situ regional cooling technique from 1983 to 2011 were assessed. To assess the combined predictive value of the significant expanded criteria donor risk criteria, the patients were divided into three groups: those with no expanded criteria donor risk factors (no risk), one expanded criteria donor risk factor (single-risk) and two or more expanded criteria donor risk factors (multiple-risk). Results: Among the donor factors, age ≥50 years, hypertension, maximum serum creatinine level ≥1.5 mg/dL and a warm ischemia time ≥30 min were identified as independent predictors of long-term graft failure on multivariate analysis. Regarding the expanded criteria donors criteria for marginal donors, cerebrovascular disease, hypertension and maximum serum creatinine level ≥1.5 mg/dL were identified as significant predictors on univariate analysis. The single- and multiple-risk groups showed 2.01- and 2.40-fold higher risks of graft loss, respectively. Conclusions: Renal grafts recovered from donors after cardiac death donors have a good renal function with an excellent long-term graft survival. However, an increased number of expanded criteria donors risk factors increase the risk of graft loss.",
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Combined predictive value of the expanded donor criteria for long-term graft survival of kidneys from donors after cardiac death : A single-center experience over three decades. / Kusaka, Mamoru; Kubota, Yusuke; Sasaki, Hitomi; Fukami, Naohiko; Fujita, Tamio; Hirose, Yuichi; Takahashi, Hiroshi; Kenmochi, Takashi; Shiroki, Ryoichi; Hoshinaga, Kiyotaka.

In: International Journal of Urology, Vol. 23, No. 4, 01.04.2016, p. 319-324.

Research output: Contribution to journalArticle

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T1 - Combined predictive value of the expanded donor criteria for long-term graft survival of kidneys from donors after cardiac death

T2 - A single-center experience over three decades

AU - Kusaka, Mamoru

AU - Kubota, Yusuke

AU - Sasaki, Hitomi

AU - Fukami, Naohiko

AU - Fujita, Tamio

AU - Hirose, Yuichi

AU - Takahashi, Hiroshi

AU - Kenmochi, Takashi

AU - Shiroki, Ryoichi

AU - Hoshinaga, Kiyotaka

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Objectives: Kidneys procured from the deceased hold great potential for expanding the donor pool. The aims of the present study were to investigate the post-transplant outcomes of renal allografts recovered from donors after cardiac death, to identify risk factors affecting the renal prognosis and to compare the long-term survival from donors after cardiac death according to the number of risk factors shown by expanded criteria donors. Methods: A total of 443 grafts recovered using an in situ regional cooling technique from 1983 to 2011 were assessed. To assess the combined predictive value of the significant expanded criteria donor risk criteria, the patients were divided into three groups: those with no expanded criteria donor risk factors (no risk), one expanded criteria donor risk factor (single-risk) and two or more expanded criteria donor risk factors (multiple-risk). Results: Among the donor factors, age ≥50 years, hypertension, maximum serum creatinine level ≥1.5 mg/dL and a warm ischemia time ≥30 min were identified as independent predictors of long-term graft failure on multivariate analysis. Regarding the expanded criteria donors criteria for marginal donors, cerebrovascular disease, hypertension and maximum serum creatinine level ≥1.5 mg/dL were identified as significant predictors on univariate analysis. The single- and multiple-risk groups showed 2.01- and 2.40-fold higher risks of graft loss, respectively. Conclusions: Renal grafts recovered from donors after cardiac death donors have a good renal function with an excellent long-term graft survival. However, an increased number of expanded criteria donors risk factors increase the risk of graft loss.

AB - Objectives: Kidneys procured from the deceased hold great potential for expanding the donor pool. The aims of the present study were to investigate the post-transplant outcomes of renal allografts recovered from donors after cardiac death, to identify risk factors affecting the renal prognosis and to compare the long-term survival from donors after cardiac death according to the number of risk factors shown by expanded criteria donors. Methods: A total of 443 grafts recovered using an in situ regional cooling technique from 1983 to 2011 were assessed. To assess the combined predictive value of the significant expanded criteria donor risk criteria, the patients were divided into three groups: those with no expanded criteria donor risk factors (no risk), one expanded criteria donor risk factor (single-risk) and two or more expanded criteria donor risk factors (multiple-risk). Results: Among the donor factors, age ≥50 years, hypertension, maximum serum creatinine level ≥1.5 mg/dL and a warm ischemia time ≥30 min were identified as independent predictors of long-term graft failure on multivariate analysis. Regarding the expanded criteria donors criteria for marginal donors, cerebrovascular disease, hypertension and maximum serum creatinine level ≥1.5 mg/dL were identified as significant predictors on univariate analysis. The single- and multiple-risk groups showed 2.01- and 2.40-fold higher risks of graft loss, respectively. Conclusions: Renal grafts recovered from donors after cardiac death donors have a good renal function with an excellent long-term graft survival. However, an increased number of expanded criteria donors risk factors increase the risk of graft loss.

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