- Email: [email protected]
Complications of Transplantation of Kidneys From Expanded-Criteria Donors
Complications of Transplantation of Kidneys From Expanded-Criteria Donors P. Domagala, A. Kwiatkowski, M. Wszola, J. Czerwinski, K. Cybula, J. Trzebicki, and A. Chmura ABSTRACT Background. Organ shortage is the primary barrier to kidney transplantation. To maximize organ use, organs from expanded-criteria donors (ECDs) have been used increasingly. Expanded-criteria donors are defined as individuals older than 60 years or older than 50 years with at least 2 of the following risk factors: hypertension, stroke as the cause of death, or serum creatinine concentration greater than 1.5 mg/dL. Objective. To assess the incidence of complications posttransplantation in ECD kidneys compared with kidneys from standard-criteria cadaveric donors (SCDs). Patients and Methods. One hundred seventy-two patients received cadaveric renal transplants between January 1, 2006, and August 31, 2008. Donor and recipient data were collected, as well as patient and graft survival and immediate, delayed, or slow graft function. Complication rates for lymphocele, urinary leak, thrombosis, hematoma, urinary tract infection, and cytomegalovirus infection were recorded. Follow-up was for 3 to 35 months, ending on November 30, 2008. Results. Overall, mean 1-year graft survival was 86.9%, and mean creatinine concentration was 1.58 mg/dL. One incidence of primary nonfunction (0.6%) was observed. More than 25% of transplanted kidneys were from ECDs. No significant differences were noted in postoperative complications between recipients of ECD or SCD organs. Conclusion. The rate of complications in recipients of ECD and SCD kidneys is comparable. IDNEY TRANSPLANTATION is the treatment of choice in patients with end-stage renal disease. Cadaveric donor shortage is the primary factor limiting access to transplantation. To maximize organ use, expanded-criteria donor (ECD) organs have been used increasingly.1 An ECD is defined as an individual older than 60 years or older than 50 years with at least 2 of the following features: hypertension, stroke as the cause of death, or serum creatinine concentration greater than 1.5 mg/dL.2 Recipients of kidneys from ECDs are at 1.7-fold increased risk of graft loss compared with recipients of kidneys from an ideal donor, defined as an individual aged 10 to 39 years, without hypertension or stroke as the cause of death, and with serum creatinine concentration less than 1.5 mg/dL.3,4 Reported results of transplantation of kidneys from ECDs have been disparate.5,6 Ratner et al7 observed that transplantation of kidneys from donors younger than 5 years is associated with an increased urinary complication rate. However, Stratta et al8 did not confirm those results using
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the contemporary definition of ECD. The objective of the present study was to assess the incidence of complications after transplantation of kidneys from ECDs compared with kidneys from standard-criteria donors (SCDs). PATIENTS AND METHODS One hundred seventy-two patients received cadaveric renal transplants between January 1, 2006, and August 31, 2008. Donor and recipient data were collected, as well as patient and graft survival and immediate, delayed, or slow graft function. Complication rates From the Departments of General Surgery and Transplantology (P.D., A.K., M.W., K.C., A.C.), Surgical and Transplant Nursing (J.C.), and Anaesthesiology and Intensive Care (J.T.), Medical University of Warsaw, and the Polish Transplant Coordinating Center, Poltransplant (J.C.), Warsaw, Poland. Address reprint requests to Piotr Domagala, MD, PhD, Department of General Surgery and Transplantology, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland. E-mail: [email protected]
0041-1345/09/$–see front matter doi:10.1016/j.transproceed.2009.07.085
© 2009 Published by Elsevier Inc. 360 Park Avenue South, New York, NY 10010-1710
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Transplantation Proceedings, 41, 2970 –2971 (2009)
COMPLICATIONS WITH EXPANDED-CRITERIA ORGANS for lymphocele, urinary leak, thrombosis, hematoma, urinary tract infection, and cytomegalovirus infection were recorded. Kidney function was assessed using serum creatinine concentration and creatinine clearance (Cockroft-Gault formula) at 7 days and at 1, 3, 6, 12, and 24 months posttransplantation. Patients were followed up for 3 to 35 months, ending on November 30, 2008. Comparisons between variables were assessed using the 2 test or the CochraneMantel-Haenszel test. The t test or Wilcoxon test was used to evaluate differences between mean and median values, respectively.
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with cold ischemia time higher than 36 hours were excluded from the final analysis. There were no significant differences in postoperative complications between recipients of SCD or ECD kidneys (Table 1). CONCLUSION
The rate of complications in recipients of ECD kidneys is comparable to that in recipients of SCD kidneys. REFERENCES
RESULTS
One incidence of primary nonfunction (0.5%) was observed. More than 25% of kidneys were from ECDs. Overall, mean 1-year graft survival was 86.9%, and mean serum creatinine concentration was 1.58 mg/dL. In order to obtain comparable groups of recipients, those with acute coronary episodes older than 55 years who received kidneys Table 1. Complications After Kidney Transplantation* Complication
SCD (n ⫽ 86)
ECD (n ⫽ 14)
Lymphocele Urinary leak Thrombosis Hematoma Urinary tract infection CMV infection
7.1 0.01 0 0.01 38.8 14.3
0 0 0 0.04 28.6 7.1
CMV ⫽ cytomegalovirus; ECD ⫽ expanded-criteria donor; SCD ⫽ standardcriteria donor. *Values are given as percentage. No significant differences were observed between comparable groups.
1. Available from http://www.unos.org. Accessed November 15, 2008 2. Stratta RJ, Rohr MS, Sundberg AK, et al: Increased kidney transplantation utilizing expanded criteria deceased organ donors with results comparable to standard criteria donor transplant. Ann Surg 239:688, 2004 3. Port FK: Organ donation and transplantation trends in the United States, 2001. Am J Transplant 3(suppl 4):7, 2003 4. Metzger RA, Delmonico FL, Feng S, et al: Expanded criteria donors for kidney transplantation. Am J Transplant 3(suppl 4):114, 2003 5. Carroll RP, Macgregor L, Walker RG: The improvement in survival of expanded criteria donor kidneys with transplantation era. Clin Transplant 22:324, 2008 6. Sellers MT, Velidedeoglu E, Bloom RD, et al: Expandedcriteria donor kidneys: a single-center clinical and short-term financial analysis; cause for concern in retransplantation. Transplantation 78:1670, 2004 7. Ratner LE, Kraus E, Magnuson T, et al: Transplantation of kidneys from expanded criteria donors. Surgery 119:372, 1996 8. Stratta RJ, Rohr MS, Sundberg AK, et al: Intermediate-term outcomes with expanded criteria deceased donors in kidney transplantation: a spectrum or specter of quality? Ann Surg 243:594, 2006
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the contemporary definition of ECD. The objective of the present study was to assess the incidence of complications after transplantation of kidneys from ECDs compared with kidneys from standard-criteria donors (SCDs). PATIENTS AND METHODS One hundred seventy-two patients received cadaveric renal transplants between January 1, 2006, and August 31, 2008. Donor and recipient data were collected, as well as patient and graft survival and immediate, delayed, or slow graft function. Complication rates From the Departments of General Surgery and Transplantology (P.D., A.K., M.W., K.C., A.C.), Surgical and Transplant Nursing (J.C.), and Anaesthesiology and Intensive Care (J.T.), Medical University of Warsaw, and the Polish Transplant Coordinating Center, Poltransplant (J.C.), Warsaw, Poland. Address reprint requests to Piotr Domagala, MD, PhD, Department of General Surgery and Transplantology, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland. E-mail: [email protected]
0041-1345/09/$–see front matter doi:10.1016/j.transproceed.2009.07.085
© 2009 Published by Elsevier Inc. 360 Park Avenue South, New York, NY 10010-1710
2970
Transplantation Proceedings, 41, 2970 –2971 (2009)
COMPLICATIONS WITH EXPANDED-CRITERIA ORGANS for lymphocele, urinary leak, thrombosis, hematoma, urinary tract infection, and cytomegalovirus infection were recorded. Kidney function was assessed using serum creatinine concentration and creatinine clearance (Cockroft-Gault formula) at 7 days and at 1, 3, 6, 12, and 24 months posttransplantation. Patients were followed up for 3 to 35 months, ending on November 30, 2008. Comparisons between variables were assessed using the 2 test or the CochraneMantel-Haenszel test. The t test or Wilcoxon test was used to evaluate differences between mean and median values, respectively.
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with cold ischemia time higher than 36 hours were excluded from the final analysis. There were no significant differences in postoperative complications between recipients of SCD or ECD kidneys (Table 1). CONCLUSION
The rate of complications in recipients of ECD kidneys is comparable to that in recipients of SCD kidneys. REFERENCES
RESULTS
One incidence of primary nonfunction (0.5%) was observed. More than 25% of kidneys were from ECDs. Overall, mean 1-year graft survival was 86.9%, and mean serum creatinine concentration was 1.58 mg/dL. In order to obtain comparable groups of recipients, those with acute coronary episodes older than 55 years who received kidneys Table 1. Complications After Kidney Transplantation* Complication
SCD (n ⫽ 86)
ECD (n ⫽ 14)
Lymphocele Urinary leak Thrombosis Hematoma Urinary tract infection CMV infection
7.1 0.01 0 0.01 38.8 14.3
0 0 0 0.04 28.6 7.1
CMV ⫽ cytomegalovirus; ECD ⫽ expanded-criteria donor; SCD ⫽ standardcriteria donor. *Values are given as percentage. No significant differences were observed between comparable groups.
1. Available from http://www.unos.org. Accessed November 15, 2008 2. Stratta RJ, Rohr MS, Sundberg AK, et al: Increased kidney transplantation utilizing expanded criteria deceased organ donors with results comparable to standard criteria donor transplant. Ann Surg 239:688, 2004 3. Port FK: Organ donation and transplantation trends in the United States, 2001. Am J Transplant 3(suppl 4):7, 2003 4. Metzger RA, Delmonico FL, Feng S, et al: Expanded criteria donors for kidney transplantation. Am J Transplant 3(suppl 4):114, 2003 5. Carroll RP, Macgregor L, Walker RG: The improvement in survival of expanded criteria donor kidneys with transplantation era. Clin Transplant 22:324, 2008 6. Sellers MT, Velidedeoglu E, Bloom RD, et al: Expandedcriteria donor kidneys: a single-center clinical and short-term financial analysis; cause for concern in retransplantation. Transplantation 78:1670, 2004 7. Ratner LE, Kraus E, Magnuson T, et al: Transplantation of kidneys from expanded criteria donors. Surgery 119:372, 1996 8. Stratta RJ, Rohr MS, Sundberg AK, et al: Intermediate-term outcomes with expanded criteria deceased donors in kidney transplantation: a spectrum or specter of quality? Ann Surg 243:594, 2006