Early Graft Loss Following Transplantation From Expanded Criteria Donors
BACKGROUND. Expanded criteria donor (ECD) kidneys are associated with higher graft loss rates than standard criteria donor kidneys. We sought to determine factors associated with early graft loss and their discrimination ability for this outcome compared with kidney donor risk index. METHODS. Data w...
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ftpubmed:oai:pubmedcentral.nih.gov:8547939 2023-05-15T16:16:51+02:00 Early Graft Loss Following Transplantation From Expanded Criteria Donors Larkins, Nicholas G. Wong, Germaine Johnson, David W. Hawley, Carmel Teixeira-Pinto, Armando Pleass, Henry Pilmore, Helen Lim, Wai H. 2021-10-22 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547939/ https://doi.org/10.1097/TXD.0000000000001235 en eng Lippincott Williams & Wilkins http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547939/ http://dx.doi.org/10.1097/TXD.0000000000001235 Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. CC-BY-NC-ND Transplant Direct Organ Donation and Procurement Text 2021 ftpubmed https://doi.org/10.1097/TXD.0000000000001235 2021-10-31T01:00:14Z BACKGROUND. Expanded criteria donor (ECD) kidneys are associated with higher graft loss rates than standard criteria donor kidneys. We sought to determine factors associated with early graft loss and their discrimination ability for this outcome compared with kidney donor risk index. METHODS. Data were extracted from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) for ECD transplants between 1997 and 2014. The primary outcome was early graft loss (all-cause graft loss within 3 y of transplantation). Death-censored graft loss was substituted as a sensitivity analysis. Era-adjusted odds ratios were calculated by multivariable logistic regression for donor, recipient, and transplant factors available at transplantation. Discrimination was assessed by c-statistic, with 95% confidence intervals (CIs) calculated by bootstrapping. RESULTS. Of 2152 ECD kidney transplants, early graft loss occurred in 406 (19%) and was associated with recipient diabetes, smoking, First Nations recipients, and oliguria. Of factors defining ECD (age, elevated terminal creatinine, hypertension, death from cerebrovascular accident), all but mode of death were associated with early graft loss. The multivariable model, including known donor, recipient, and transplant factors, was moderately good at predicting early graft loss (c-statistic 0.65; 95% CI, 0.62-0.68). Recipient factors (c-statistic 0.62; 95% CI, 0.59-0.65) performed equally well compared with donor factors (c-statistic 0.60; 95% CI, 0.57-0.64) or the kidney donor risk index (c-statistic 0.60; 95% CI, 0.56-0.63). CONCLUSIONS. Early graft loss occurs in approximately one-fifth of ECD kidney transplants. The discriminatory value of commonly used recipient, donor, and transplant factors are approximately comparable and limited. Text First Nations PubMed Central (PMC) New Zealand Transplantation Direct 7 11 e783 |
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English |
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Organ Donation and Procurement |
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Organ Donation and Procurement Larkins, Nicholas G. Wong, Germaine Johnson, David W. Hawley, Carmel Teixeira-Pinto, Armando Pleass, Henry Pilmore, Helen Lim, Wai H. Early Graft Loss Following Transplantation From Expanded Criteria Donors |
topic_facet |
Organ Donation and Procurement |
description |
BACKGROUND. Expanded criteria donor (ECD) kidneys are associated with higher graft loss rates than standard criteria donor kidneys. We sought to determine factors associated with early graft loss and their discrimination ability for this outcome compared with kidney donor risk index. METHODS. Data were extracted from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) for ECD transplants between 1997 and 2014. The primary outcome was early graft loss (all-cause graft loss within 3 y of transplantation). Death-censored graft loss was substituted as a sensitivity analysis. Era-adjusted odds ratios were calculated by multivariable logistic regression for donor, recipient, and transplant factors available at transplantation. Discrimination was assessed by c-statistic, with 95% confidence intervals (CIs) calculated by bootstrapping. RESULTS. Of 2152 ECD kidney transplants, early graft loss occurred in 406 (19%) and was associated with recipient diabetes, smoking, First Nations recipients, and oliguria. Of factors defining ECD (age, elevated terminal creatinine, hypertension, death from cerebrovascular accident), all but mode of death were associated with early graft loss. The multivariable model, including known donor, recipient, and transplant factors, was moderately good at predicting early graft loss (c-statistic 0.65; 95% CI, 0.62-0.68). Recipient factors (c-statistic 0.62; 95% CI, 0.59-0.65) performed equally well compared with donor factors (c-statistic 0.60; 95% CI, 0.57-0.64) or the kidney donor risk index (c-statistic 0.60; 95% CI, 0.56-0.63). CONCLUSIONS. Early graft loss occurs in approximately one-fifth of ECD kidney transplants. The discriminatory value of commonly used recipient, donor, and transplant factors are approximately comparable and limited. |
format |
Text |
author |
Larkins, Nicholas G. Wong, Germaine Johnson, David W. Hawley, Carmel Teixeira-Pinto, Armando Pleass, Henry Pilmore, Helen Lim, Wai H. |
author_facet |
Larkins, Nicholas G. Wong, Germaine Johnson, David W. Hawley, Carmel Teixeira-Pinto, Armando Pleass, Henry Pilmore, Helen Lim, Wai H. |
author_sort |
Larkins, Nicholas G. |
title |
Early Graft Loss Following Transplantation From Expanded Criteria Donors |
title_short |
Early Graft Loss Following Transplantation From Expanded Criteria Donors |
title_full |
Early Graft Loss Following Transplantation From Expanded Criteria Donors |
title_fullStr |
Early Graft Loss Following Transplantation From Expanded Criteria Donors |
title_full_unstemmed |
Early Graft Loss Following Transplantation From Expanded Criteria Donors |
title_sort |
early graft loss following transplantation from expanded criteria donors |
publisher |
Lippincott Williams & Wilkins |
publishDate |
2021 |
url |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547939/ https://doi.org/10.1097/TXD.0000000000001235 |
geographic |
New Zealand |
geographic_facet |
New Zealand |
genre |
First Nations |
genre_facet |
First Nations |
op_source |
Transplant Direct |
op_relation |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547939/ http://dx.doi.org/10.1097/TXD.0000000000001235 |
op_rights |
Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
op_rightsnorm |
CC-BY-NC-ND |
op_doi |
https://doi.org/10.1097/TXD.0000000000001235 |
container_title |
Transplantation Direct |
container_volume |
7 |
container_issue |
11 |
container_start_page |
e783 |
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1766002704561209344 |