Assessing the eligibility of kidney transplant donors

Organ transplantation is a highly complex decision processthat requires expert decisions. The major problem in a transplantationprocedure is the possibility of the receiver's immune system attack anddestroy the transplanted tissue. It is therefore of capital importance tond a donor with the highest possible compatibility with the receiver, andthus reduce rejection. Finding a good donor is not a straightforward taskbecause a complex network of relations exists between the immunologicaland the clinical variables that inuence the receiver's acceptance of thetransplanted organ. Currently the process of analyzing these variablesinvolves a careful study by the clinical transplant team. The number andcomplexity of the relations between variables make the manual processvery slow. In this paper we propose and compare two Machine Learningalgorithms that might help the transplant team in improving and speedingup their decisions. We achieve that objective by analyzing past real casesand constructing models as set of rules. Such models are accurate andunderstandable by experts

Specific issues concerning the management of patients on the waiting list and after liver transplantation

The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system

Assessment of GFR in the evaluation of potential living kidney donors at the Wits Donald Dordon Medical Center (WDGMC) and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH)

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine Johannesburg, 2018.Equations that estimate GFR (eGFR) are widely used in clinical practice to estimate kidney function in sub-Saharan Africa, but have not been validated for use in this region. This study assessed the performance of eGFR equations in adults evaluated for suitability for live kidney donation against a gold standard radionuclear GFR measurement (mGFR) and determined their usefulness for screening live kidney donors in South Africa. This study was a retrospective record review of 350 adults evaluated for living kidney donation from 1996 – 2013 at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Wits Donald Gordon Medical Centre (WDGMC). Their eGFR was calculated using CG, 4-v MDRD and CKD-EPI equations. Plasma clearance of 51Cr-EDTA was used as a reference method for mGFR. The 4-v MDRD (with and without ethnicity adjustment) and the CKD-EPI (without ethnicity adjustment) equations underestimated the mGFR (negative bias of -8 mL/min/1.73m2, -16 mL/min/-1.73m2 and -6.4 mL/min/1.73m2 respectively).However, the bias associated with the average mGFR using the CG and CKD-EPI (with ethnicity adjustment) equations was not significant (2.3 mL/min/1.73m2 and 0.6 respectively).Use of the ethnicity factor resulted in overestimation of mGFR for both the 4v-MDRD equation (by 24.2ml/min/1.73m2 compared to 6.8 ml/min/1.73m2 without it) and the CKD-EPI equation (by 21.8ml/min/1.73m2, compared to 7.6ml/min/1.73m2, without the ethnicity factor). In conclusion, this study showed that almost half of adults screened for living donation in Johannesburg were not eligible due to comorbid hypertension, diabetes and unexplained kidney disease. In addition, the error statistics worsened as mGFR increased and all four prediction equations had a low sensitivity for determining individuals with a GFR <80 ml/min/1.73m2. Based on the findings in this study, use of a gold standard measured GFR should be the preferred method for assessing kidney function in potential living kidney donors in South Africa.LG201

Francisella tularensis Transmission by Solid Organ Transplantation, 20171.

In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor's residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation

Reverse Transplant Tourism

In this article, we propose a novel form of kidney swap, which we label “Reverse Transplant Tourism.” This proposal has the potential to increase the number of successful transplants in the US at a time of great need, while reducing costs. It also will provide benefits to impoverished international patients with willing, compatible donors who otherwise would have no access to transplantation. Instead of non-US kidney donors being offered money through a black market middleman in exchange for one of their kidneys, Reverse Transplant Tourism would provide a legal and ethical exchange of living donor kidneys through kidney-paired donation. In this way, the donors will not receive money for their kidneys, but rather will receive a transplant for someone they love, while also helping a US pair who would otherwise be unable to transplant due to biological incompatibility

Combining transplant professional's psychosocial donor evaluation and donor self-report measures to optimise the prediction of HRQoL after kidney donation:an observational prospective multicentre study

OBJECTIVES: Living donor kidney transplantation is currently the preferred treatment for patients with end-stage renal disease. The psychosocial evaluation of kidney donor candidates relies mostly on the clinical viewpoint of transplant professionals because evidence-based guidelines for psychosocial donor eligibility are currently lacking. However, the accuracy of these clinical risk judgements and the potential added value of a systematic self-reported screening procedure are as yet unknown. The current study examined the effectiveness of the psychosocial evaluation by transplant professionals and the potential value of donor self-report measures in optimising the donor evaluation. Based on the stress-vulnerability model, the predictive value of predonation, intradonation and postdonation factors to impaired longer term health-related quality of life (HRQoL) of kidney donors was studied. DESIGN: An observational prospective multicentre study. SETTING: Seven Dutch transplantation centres. PARTICIPANTS: 588 potential donors participated, of whom 361 donated. Complete prospective data of 230 donors were available. Also, 1048 risk estimation questionnaires were completed by healthcare professionals. METHODS: Transplant professionals (nephrologists, coordinating nurses, social workers and psychologists) filled in risk estimation questionnaires on kidney donor candidates. Furthermore, 230 kidney donors completed questionnaires (eg, on HRQoL) before and 6 and 12 months after donation. PRIMARY AND SECONDARY OUTCOME MEASURES: HRQoL, demographic and preoperative, intraoperative and postoperative health characteristics, perceived support, donor cognitions, recipient functioning and professionals risk estimation questionnaires. RESULTS: On top of other predictors, such as the transplant professionals’ risk assessments, donor self-report measures significantly predicted impaired longer term HRQoL after donation, particularly by poorer predonation physical (17%–28% explained variance) and psychological functioning (23%). CONCLUSIONS: The current study endorses the effectiveness of the psychosocial donor evaluation by professionals and the additional value of donor self-report measures in optimising the psychosocial evaluation. Consequently, systematic screening of donors based on the most prominent risk factors provide ground for tailored interventions for donors at risk

Improving Access and Outcomes in Living Kidney Donor Transplantation

Shortages in deceased organ donation have necessitated widespread acceptance of living donor kidney transplantation, which offers better outcomes in terms of graft survival, life expectancy and quality of life for many patients with end-stage kidney disease, compared with deceased donor kidney transplantation and dialysis. However, there are barriers and challenges that exist in the current practice of living kidney donor transplantation. Overall, the rates of living kidney donor transplantation have decreased or plateaued, with ethic and socio-economic disparities in access to living kidney donation reported in many countries that remain largely unexplained. Living donors must accept risks associated with undergoing nephrectomy, yet the evidence on the long-term risks of living kidney donation remains uncertain. In response, there have been efforts to identify and describe the barriers and disparities in living kidney donor transplantation, improve the pathway for living donors and to assess a range of outcomes for living donors. A comprehensive understanding of the values, beliefs, experiences, priorities and preferences of the key stakeholders, including donors and health professionals involved in their care is needed to ensure that research; clinical practice and policy in living kidney donation address their needs and priorities. This is a thesis by publication containing published and submitted work. The aims of the studies included in this thesis are: 1) To identify and describe the beliefs, attitudes and expectations of patients with CKD regarding living kidney donation. 2) To describe kidney donors’ experiences of the evaluation process, and the motivations and challenges to sustaining commitment prior to donation. 3) To describe nephrologists’ perspectives on barriers to living kidney donation and disparities in access to living kidney donor transplantation. 4) To identify living kidney donors’ priorities for outcomes and describe the reasons for their choices. 5) To determine the characteristics and heterogeneity of outcomes reported in randomised trials and observational studies in adult living kidney donor

The Doha model of organ donation and transplantation: thinking beyond citizenship

This paper reviews the policy and practice of organ donation and transplantation in Qatar that has developed since January 2011. The important features of the Doha Model (the &lsquo;Model&rsquo;) are explored, including: (i) all legal residents of Qatar have an equal right to access deceased donor organs and transplantation regardless of their citizenship status; (ii) no prioritisation in organ allocation is given to Qatari citizens; (iii) a multilingual and multicultural education and promotional program about donation has been implemented to engage the diverse national communities resident within Qatar; (iv) financial incentives or fungible rewards for living or deceased donation are prohibited. The ethical framework of this policy will be examined in the light of the national self-sufficiency paradigm, which advocates reciprocity and solidarity among resident populations seeking to meet all needs for transplantation equitably. We review some preliminary evidence of the impact of the Model with respect to engagement of a highly diverse multinational population in a donation and transplantation program, and argue that the Model may inform policy and practice in other countries, particularly those with non-citizen resident populations

Protocol of a Randomized Controlled Trial of Culturally Sensitive Interventions to Improve African Americans' and Non-African Americans' Early, Shared, and Informed Consideration of Live Kidney Transplantation: The talking about Live Kidney Donation (TALK) study

<p>Abstract</p> <p>Background</p> <p>Live kidney transplantation (LKT) is underutilized, particularly among ethnic/racial minorities. The effectiveness of culturally sensitive educational and behavioral interventions to encourage patients' early, shared (with family and health care providers) and informed consideration of LKT and ameliorate disparities in consideration of LKT is unknown.</p> <p>Methods/Design</p> <p>We report the protocol of the Talking About Live Kidney Donation (TALK) Study, a two-phase study utilizing qualitative and quantitative research methods to design and test culturally sensitive interventions to improve patients' shared and informed consideration of LKT. Study Phase 1 involved the evidence-based development of culturally sensitive written and audiovisual educational materials as well as a social worker intervention to encourage patients' engagement in shared and informed consideration of LKT. In Study Phase 2, we are currently conducting a randomized controlled trial in which participants with progressing chronic kidney disease receive: 1) usual care by their nephrologists, 2) usual care plus the educational materials, or 3) usual care plus the educational materials and the social worker intervention. The primary outcome of the randomized controlled trial will include patients' self-reported rates of consideration of LKT (including family discussions of LKT, patient-physician discussions of LKT, and identification of an LKT donor). We will also assess differences in rates of consideration of LKT among African Americans and non-African Americans.</p> <p>Discussion</p> <p>The TALK Study rigorously developed and is currently testing the effectiveness of culturally sensitive interventions to improve patients' and families' consideration of LKT. Results from TALK will provide needed evidence on ways to enhance consideration of this optimal treatment for patients with end stage renal disease.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov number, <a href="http://www.clinicaltrials.gov/ct2/show/NCT00932334">NCT00932334</a></p

Outcomes in Living Donor Kidney Transplantation: The Role of Donor's Kidney Function

Introduction: Living donor kidney transplant (LDKT) is one of the best therapeutic options for end-stage kidney disease (ESKD). Guidelines identify different estimated glomerular filtration rate (eGFR) thresholds to determine the eligibility of donors. The aim of our study was to evaluate whether pretransplant donor eGFR was associated with kidney function in the recipient. Methods: We retrospectively studied LDKT recipients who received a kidney graft between September 1, 2005, and June 30, 2016 in the same transplant center in France and that had eGFR data available at 3, 12, 24, and 36 months posttransplant. Results: We studied 90 donor-recipient pairs. The average age at time of transplant was 51.47 ± 10.95 for donors and 43.04 ± 13.52 years for recipients. Donors' average eGFR was 91.99 ± 15.37 mL/min/1.73 m2. Donor's age and eGFR were significantly correlated (p &#x3c; 0.0001, r2 0.023). Donor's age and eGFR significantly correlated with recipient's eGFR at 3, 12, and 24 months posttransplant (age: p &#x3c; 0.001 at all intervals; eGFR p = 0.001, 0.003, and 0.016, respectively); at 36 months, only donor's age significantly correlated with recipient's eGFR. BMI, gender match, and year of kidney transplant did not correlate with graft function. In the multivariable analyses, donor's eGFR and donor's age were found to be associated with graft function; correlation with eGFR was lost at 36 months; and donor's age retained a strong correlation with graft function at all intervals (p &#x3c; 0.001). Conclusions: Donor's eGFR and age are strong predictors of recipient's kidney function at 3 years. We suggest that donor's eGFR should be clinically balanced with other determinants of kidney function and in particular with age