Favorable Living Donor Kidney Transplantation Outcomes within a National Kidney Exchange Program
Rattachement africain : gb, nl, ca. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Key Points KEP recipients have comparable long-term graft survival to direct living donor kidney transplantation recipients, which underscores the need to prioritize KEP over other's therapies. Our outcomes can be achieved regardless of whether the donor travels or the graft is transported, offering flexibility in program implementation. Background KEPs (kidney exchange programs) facilitate living donor kidney transplantations (LDKTs) for patients with incompatible donors, who are typically at higher risk than non-KEP patients because of higher sensitization and longer dialysis vintage. We conducted a comparative analysis of graft outcomes and risk factors for both KEP and non-KEP living donor kidney transplants. Methods All LDKTs performed in The Netherlands between 2004 and 2021 were included. The primary outcome measures were 1-, 5-, and 10-year death-censored graft survival. The secondary outcome measures were delayed graft function, graft function, rejection rates, and patient survival. We used a propensity score–matching model to account for differences at baseline. Results Of 7536 LDKTs, 694 (9%) were transplanted through the KEP. Ten-year graft survival was similar for KEP (0.916; 95% confidence interval, 0.894 to 0.939) and non-KEP (0.919; 0.912 to 0.926, P = 0.82). We found significant differences in 5-year rejection (12% versus 7%) and 5-year patient survival (KEP: 84%, non-KEP: 90%), which was nonsignificant after propensity score matching. Significant risk factors of lower graft survival included high donor age, retransplantations, extended dialysis vintage, higher panel reactive antibodies, and nephrotic syndrome as the cause of ESKD. Conclusions Transplantation through KEP offers a viable alternative for patients lacking compatible donors, avoiding specific and invasive pre- and post-transplant treatments. KEP's similar survival rate to non-KEPs suggests prioritizing KEP LDKTs over deceased donor kidney transplantation, desensitization, and dialysis. However, clinicians should consider the identified risk factors when planning and managing pre- and post-transplant care to enhance patient outcomes. Thus, we advocate for the broad adoption of KEP and establishment in regions lacking such programs, alongside initiation and expansion of international collaborations.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Favorable Living Donor Kidney Transplantation Outcomes within a National Kidney Exchange Program
- Date Crossref
- 29/01/2025
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Imperial College Healthcare NHS Trust pays non établi dans la noticeÉtablissement de santé
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Hammersmith Hospital pays non établi dans la noticeÉtablissement de santé
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Erasmus MC pays non établi dans la noticeÉtablissement de santé
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Erasmus MC Transplant Institute pays non établi dans la noticeÉtablissement de santé
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Amsterdam University Medical Centers pays non établi dans la noticeÉtablissement de santé
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Institute of Infection and Immunity pays non établi dans la noticeStructure de recherche
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University of Amsterdam Department of Internal Medicine pays non établi dans la noticeUniversité ou école supérieure
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Amsterdam UMC Location University of Amsterdam pays non établi dans la noticeÉtablissement de santé
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Leiden University Medical Center Department of Internal Medicine pays non établi dans la noticeOrganisme public
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University Medical Center Groningen pays non établi dans la noticeÉtablissement de santé
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University of Groningen Department of Internal Medicine pays non établi dans la noticeUniversité ou école supérieure
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Utrecht University Department of Surgery pays non établi dans la noticeUniversité ou école supérieure
Imperial College Healthcare NHS Trust, Hammersmith Hospital et Erasmus MC, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.