The Canadian Experience Using the Expanded Criteria Donor Classification for Allocating Deceased Donor Kidneys for Transplantation

Canadian Journal of Kidney Health and Disease - Tập 3 - Trang 106 - 2016
Ann Young1, Stephanie N. Dixon2, Greg Knoll3,2, Amit X. Garg4,2, Charmaine E. Lok1,5,2, Ngan N. Lam6, S. Joseph Kim1,5,2
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
2Institute for Clinical Evaluative Sciences, Ontario, Canada
3Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
4Division of Nephrology, Western University, London, Ontario, Canada
5Division of Nephrology, Toronto General Hospital, University Health Network, University of 585 University Avenue, 11-PMB-129 Toronto, Ontario, Canada
6Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada

Tóm tắt

Background:Although the outcomes of transplantation with expanded criteria donor (ECD) kidneys are inferior to non-ECD transplants in the USA, the impact of the ECD classification on Canadian kidney transplant recipients is not known.Objectives:The objective of the study was to assess the performance of the US-derived ECD classification among deceased donor kidney transplant recipients in a Canadian setting.Design:This study was a population-based cohort study.Setting:The study was conducted in all adult kidney transplant centers in the province of Ontario.Patients:The patients were incident-deceased donor kidney transplant recipients from January 1, 2005 to March 31, 2011.Measurements:Study subjects were identified through the Trillium Gift of Life Network and linked to healthcare databases in Ontario. ECD status was based on age, hypertension, kidney function, and stroke-related death. Outcomes of interest included graft loss, death, and delayed graft function.Methods:The Kaplan-Meier product limit method was used to graphically assess time to graft loss or death. Multivariable Cox proportional hazards models were used to assess graft loss or death as a function of ECD status. Multivariable logistic regression models were fitted for the outcome of delayed graft function.Results:Of 1422 deceased donor kidney transplants, 325 (23 %) were from ECDs. The median donor age was 63 vs. 42 years for ECD vs. non-ECD, respectively. The 5-year cumulative incidence of total graft loss was 29.2 % in ECD and 20.7 % in non-ECD kidney transplants. The relative hazards for total graft loss (HR 1.48 [95 % CI, 1.10; 2.00]) and death-censored graft loss (HR 1.80 [95 % CI, 1.19, 2.71]) were increased in ECD vs. non-ECD transplants. Increased relative risks were also observed for death and delayed graft function, albeit not statistically significant.Limitations:Although comprehensive in coverage and outcome ascertainment, the available details on covariate data may be limited in large healthcare databases.Conclusions:The ECD classification identifies kidneys at increased risk for graft loss in Canadian patients. The performance of more granular measures of donor risk (e.g., Kidney Donor Risk Index) and its impact on organ allocation/utilization in Canadian patients requires further study.

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Tài liệu tham khảo

Metzger RA, 2003, Am J Transplant, 3, 114, 10.1034/j.1600-6143.3.s4.11.x

Fan PY, 2010, Am J Transplant, 10, 1090, 10.1111/j.1600-6143.2009.03009.x

Goldstein M, 2004, Am J Kidney Dis., 44, 706, 10.1016/S0272-6386(04)00940-0

Churchill DN, 1997, J Am Soc Nephrol., 8, 965, 10.1681/ASN.V86965

2005, Trillium Gift of Life Network

Levey AS, 2006, Ann Intern Med., 145, 247, 10.7326/0003-4819-145-4-200608150-00004

Quinn RR, 2010, Med Care, 48, 745, 10.1097/MLR.0b013e3181e419fd

Pascual J, 2008, Am J Kidney Dis., 52, 553, 10.1053/j.ajkd.2008.06.005

Fine J, 1999, J Am Stat Assoc., 94, 496, 10.1080/01621459.1999.10474144

Kim SJ, 2006, Am J Transplant, 6, 109, 10.1111/j.1600-6143.2005.01141.x

Port FK, 2002, Transplantation, 74, 1281, 10.1097/00007890-200211150-00014

Collins MG, 2009, Transplantation, 87, 1201, 10.1097/TP.0b013e31819ec3a6

Aubert O, 2015, BMJ., 351, h3557, 10.1136/bmj.h3557

Schold JD, 2006, Clin J Am Soc Nephrol., 1, 532, 10.2215/CJN.01130905

Merion RM, 2005, JAMA., 294, 2726, 10.1001/jama.294.21.2726

Ojo AO, 2001, J Am Soc Nephrol., 12, 589, 10.1681/ASN.V123589

Heldal K, 2012, Am J Kidney Dis., 59, 748, 10.1053/j.ajkd.2012.03.002

Klein R, 2013, Transplantation, 95, 611, 10.1097/TP.0b013e318279153c

Morgan C, 2007, Am J Transplant, 7, 1288, 10.1111/j.1600-6143.2007.01761.x

Putter H, 2007, Stat Med., 26, 2389, 10.1002/sim.2712

Dignam JJ, 2012, Clin Cancer Res., 18, 2301, 10.1158/1078-0432.CCR-11-2097

Hofer J, 2014, Transplantation, 97, 426, 10.1097/01.tp.0000437428.12356.4a

Dare AJ, 2014, Transplantation, 97, 797, 10.1097/01.TP.0000441361.34103.53

Legendre C, 2014, Transpl Int., 27, 19, 10.1111/tri.12217

Rao PS, 2009, Transplantation, 88, 231, 10.1097/TP.0b013e3181ac620b

Charlson ME, 1987, J Chronic Dis., 40, 373, 10.1016/0021-9681(87)90171-8

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Canadian Journal of Kidney Health and Disease

Tập 3

106

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