Is the Updated Kidney Allocation System Working?

AbstractPurpose of ReviewIn December 2014, the current kidney allocation system (KAS) was implemented after over 10  years of development by the OPTN Kidney Committee. The Kidney Committee noted several limitations with the prior kidney allocation schema and sought to improve many of these limitations. This review will discuss those goals and the available results at a 2-year review.Recent FindingsTwo-year results of the new kidney allocation system: This system increased the allocation of allografts with longer expected function as estimated by the Kidney Donor Profile Index (KDPI) to those patients with longer expected post-transplant survival as estimated by the recipients ’ EPTS score or the estimated post-transplant survival score. A large increase in transplantation to those who are highly sensitized, calculated panel reactive antibody (CPRA) 98% or greater has also occurred as planned. Redefining the start of waiting time to the start of chronic dialysis time re sulted in a great increase in minority transplantation and to those with a long time of dialysis. There was a small increase in transplantation to blood type B candidates.Challenges: Organ discards have still increased compared to before the implementation of the new KAS, likely due to factors not addressed by the KAS such as the regulatory concerns (performance metric flagging) and financial costs of transplanting higher KDPI organs and higher EPTS candidates. There was a large “bolus” e...
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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Abstract This paper aims to identify the reasons for choosing or refusing kidney transplantation as renal replacement therapy among patients with Chronic Kidney Disease (CKD). Data were collected through interviews with CKD patients treated by dialysis. Health professionals were also interviewed. A thematic analysis was used to analyze the data. Results show that various reasons account for CKD patients' refusal to have a kidney transplant: the perception of kidney transplantation as a renal replacement therapy without positive outcome, refusal to have an allograft. There are also situations such as the lack of or...
Source: Nephrologie and Therapeutique - Category: Urology & Nephrology Authors: Tags: Nephrol Ther Source Type: research
Authors: Agrawal N, Garg N, Adapa S, Cardarelli F Abstract Arteriovenous graft in the thigh is used not infrequently for hemodialysis. Outcomes with this lower extremity dialysis access are generally comparable to upper extremity access and superior to long-term catheter use. However, it could have significant implications in a patient getting a kidney transplant. Here we describe a case of thigh arteriovenous graft causing kidney allograft dysfunction in a new transplant recipient, and this resolved with graft ligation. PMID: 31547759 [PubMed - as supplied by publisher]
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
This article reviews clinical data and ongoing trials with C1-INH in transplant recipients, compares the results with those of other complement inhibitors, and summarizes potentially productive directions for future research.
Source: Transplantation - Category: Transplant Surgery Tags: Reviews Source Type: research
Abstract BACKGROUND: Growth differentiation factor-15 (GDF15) is markedly increased in end-stage kidney disease and has been related to increased mortality in patients on dialysis. We hypothesized that kidney transplantation would decrease both GDF15 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and that GDF-15 decrease relates to post-kidney transplantation allograft function. METHODS: End-stage kidney disease patients on dialysis awaiting a living donor kidney transplantation (n = 39), and those expected to be on the deceased donor waitlist for at least 12 months (n = 43) were enrolled...
Source: Clinical Biochemistry - Category: Biochemistry Authors: Tags: Clin Biochem Source Type: research
Abstract BACKGROUND AND OBJECTIVES: Patients who have failed a transplant are at increased risk of repeat transplant failure. We determined access to transplantation and transplant outcomes in patients with and without a history of transplant failure. DESIGN, SETTING, PARTICIPANTS, &MEASUREMENTS: In this observational study of national data, the proportion of waitlisted patients and deceased donor transplant recipients with transplant failure was determined before and after the new kidney allocation system. Among patients initiating maintenance dialysis between May 1995 and December 2014, the likelihood o...
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
Sonia Mehrotra, Raj Kumar Sharma, Manas R PatelIndian Journal of Nephrology 2019 29(4):242-247 Vitamin-D has immuno-modulatory properties besides its role in mineral and bone disorder (MBD) and could have a role in allograft outcome. Fifty-two chronic kidney disease patients on dialysis going for transplantation were prospectively studied before and after renal transplantation. FGF23, 25(OH) vitamin D, 1,25-Dihydroxyvitamin D, PTH, serum Ca, serum PO4, and e-GFR status were evaluated. Vitamin D deficiency was seen in 25.0% of recipients before transplant (26.09 ± 12.19 ng/mL) and in 48.1% at 6 months post-tra...
Source: Indian Journal of Nephrology - Category: Urology & Nephrology Authors: Source Type: research
ConclusionClinicians prescribing ICIs should be aware that SOT recipients are at risk of transplant rejection as a result of T cell activation. Dd-cfDNA is a sensitive biomarker and should be further studied for early detection of transplant rejection. Immunological analysis of the kidney explant showed marked graft infiltration with alloreactive PD-1+ cytotoxic T cells that were saturated with nivolumab.
Source: Journal for Immunotherapy of Cancer - Category: Cancer & Oncology Source Type: research
Purpose of review The population of kidney transplant recipients with advanced chronic kidney disease is growing but their outcomes are poor and care is not standardized. There has been wide variety of research in recent years on different aspects of care in failing allografts, and these research findings may help the providers in optimizing care. The purpose of the review is to outline the challenges and opportunities in management of failing allograft, and provide tools for improvement. Recent findings This review summarizes the recent research in field of failing allograft including outcomes, immunosuppression, ris...
Source: Current Opinion in Organ Transplantation - Category: Surgery Tags: KIDNEY PANCREAS: Edited by Matthew Cooper Source Type: research
Kidney transplantation (KT) is the treatment of choice for end stage kidney disease , offering the highest survival benefit amongst all the different renal replacement therapies1. Long term renal allograft and patient survival have shown substantial improvements over time: however, death with a functioning allograft remains the leading cause of late allograft loss with cardiovascular disease (CVD) related deaths representing a major cause of mortality2. While recipients of kidney transplants have lower risk for CVD when compared to the 10-20 fold increased risk in patients with dialysis, their risk of CVD is substantially ...
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Policy Forum Source Type: research
Kidney transplantation (KT) is the treatment of choice for end-stage kidney disease, offering the highest survival benefit among all the different renal replacement therapies.1 Long-term renal allograft and patient survival have shown substantial improvements over time: however, death with a functioning allograft remains the leading cause of late allograft loss, with cardiovascular disease (CVD) –related deaths representing a major cause of mortality.2 Although recipients of KT have a lower risk of CVD as compared with the 10- to 20-fold increased risk in patients on dialysis, their risk of CVD is substantially highe...
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Policy Forum Source Type: research
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