학술논문
A Clinical Study on Deceased Kidney Donors in Puerto Rico and the Survival Outcome of the Grafts: A Retrospective Study of 187 Kidneys from 2009-2011
Document Type
Academic Journal
Author
Source
Puerto Rico Health Sciences Journal. June, 2019, Vol. 38 Issue 2, p92, 5 p.
Subject
Language
English
ISSN
0738-0658
Abstract
The principal challenge that transplant clinicians face today is to ensure long-term allograft survival. Factors impacting short- and long-term outcomes include donor and recipient characteristics, cold ischemia time, donor --recipient [...]
Objective: In this study, we assessed the Kidney Donor Risk Index (KDRI) in Puerto Rican deceased kidney donors whose donations took place from 2009 to 2011 and evaluated short-term graft survival in the recipients of those kidneys. The results highlight differences between the distributions of KDRI values in the populations of the 48 contiguous states of the United States, Alaska, and Hawaii and that of Puerto Rico. Additionally, we evaluated the impacts of polyomavirus (BKV) infection and anti-donor HLA antibodies on the recipients. Methods: Of the 377 kidneys obtained from deceased donors by LifeLink of Puerto Rico from 2009 to 2011, 187 were transplanted in Puerto Rico. Data was collected from the deceased donors of these 187 kidneys for calculating KDRI, as well as from the transplant recipients. KDRI values of the donors were calculated using the same formula as previously reported for the United States; death-censored graft survival, incidence of antibody-mediated rejection, and prevalence of polyoma virus infection (BKV) were examined in the recipients. Results: The mean KDRI value was 1.19. However, the distribution of KDRI values in the Puerto Rican population deviates substantially from that of the United States (not including Puerto Rico). A 1-peak distribution pattern describes Puerto Rican KDRI values. Graft survival for the study period was 89.6%. The prevalence of BKV was 16.9%. Of the patients studied, 6.25% developed overt nephropathy, 46.2% developed de novo post-transplant donor-specific alloantibodies, and 19.5% had pre-existing alloantibodies. Conclusion: Our study evidences the role of various characteristics in the distribution of KDRI values in the Puerto Rican population, suggesting that the identification of variables specific to a geographically distinct group may result in better donor categorization for predicting transplant outcomes. In addition, our graft-survival results, despite the elevated rates of BKV and anti-donor antibodies, highlight the increasing need to monitor the presence of antibodies in a prospective and an anticipatory manner to identify and manage patients at risk for antibody-mediated rejection. [P R Health Sci J 2019;38:92-96] Key words: Kidney transplantation, Kidney donation, BKV, Kidney Donor Risk Index Objetivo: El proposito de este estudio es evaluar el indice de riesgo del rinon donado (KDRI, por sus siglas en ingles) en los rinones donados por puertorriquenos en los anos 2009 al 2011. En adicion, se busca estudiar la sobrevida del organo a corto plazo. Los resultados obtenidos evidencian una diferencia sustancial en la distribucion de los valores del KDRI entre las poblaciones puertorriquena y estadounidense. Metodos: De los 377 rinones cadavericos donados a traves de LifeLink de Puerto Rico desde el 2009 al 2011, 187 rinones fueron trasplantados localmente. Se recogieron datos de los donantes de estos 187 rinones para calcular el KDRI. Los valores del KDRI fueron calculados usando el mismo metodo computacional utilizado en los Estados Unidos. La sobrevida del organo, la incidencia de rechazo mediada por anticuerpos y la prevalencia de infeccion con el virus de polioma BK (VBK) fueron examinadas en los recipientes. Resultados: El valor promedio de KDRI fue de 1.19. La distribucion de los valores de KDRI en la poblacion puertorriquena se desvia sustancialmente de la estadounidense. La sobrevida de la cohorte de organos donados fue de 89.6% a los 3 anos. La prevalencia de VBK en suero fue de 16.9%. De estos pacientes, 6.25% desarrollaron nefropatia, 46.2% desarrollaron anticuerpos especificos al donante de novo y 19.5% tenian estos anticuerpos anterior al trasplante. Conclusion: Nuestro estudio demuestra el papel que juegan las caracteristicas de la poblacion puertorriquena en la distribucion de los valores del KDRI. Esto puede sugerir que la identificacion de variables especificas a distintos grupos geograficos podria resultar en mejor clasificacion de donantes y prediccion de resultados.
Objective: In this study, we assessed the Kidney Donor Risk Index (KDRI) in Puerto Rican deceased kidney donors whose donations took place from 2009 to 2011 and evaluated short-term graft survival in the recipients of those kidneys. The results highlight differences between the distributions of KDRI values in the populations of the 48 contiguous states of the United States, Alaska, and Hawaii and that of Puerto Rico. Additionally, we evaluated the impacts of polyomavirus (BKV) infection and anti-donor HLA antibodies on the recipients. Methods: Of the 377 kidneys obtained from deceased donors by LifeLink of Puerto Rico from 2009 to 2011, 187 were transplanted in Puerto Rico. Data was collected from the deceased donors of these 187 kidneys for calculating KDRI, as well as from the transplant recipients. KDRI values of the donors were calculated using the same formula as previously reported for the United States; death-censored graft survival, incidence of antibody-mediated rejection, and prevalence of polyoma virus infection (BKV) were examined in the recipients. Results: The mean KDRI value was 1.19. However, the distribution of KDRI values in the Puerto Rican population deviates substantially from that of the United States (not including Puerto Rico). A 1-peak distribution pattern describes Puerto Rican KDRI values. Graft survival for the study period was 89.6%. The prevalence of BKV was 16.9%. Of the patients studied, 6.25% developed overt nephropathy, 46.2% developed de novo post-transplant donor-specific alloantibodies, and 19.5% had pre-existing alloantibodies. Conclusion: Our study evidences the role of various characteristics in the distribution of KDRI values in the Puerto Rican population, suggesting that the identification of variables specific to a geographically distinct group may result in better donor categorization for predicting transplant outcomes. In addition, our graft-survival results, despite the elevated rates of BKV and anti-donor antibodies, highlight the increasing need to monitor the presence of antibodies in a prospective and an anticipatory manner to identify and manage patients at risk for antibody-mediated rejection. [P R Health Sci J 2019;38:92-96] Key words: Kidney transplantation, Kidney donation, BKV, Kidney Donor Risk Index Objetivo: El proposito de este estudio es evaluar el indice de riesgo del rinon donado (KDRI, por sus siglas en ingles) en los rinones donados por puertorriquenos en los anos 2009 al 2011. En adicion, se busca estudiar la sobrevida del organo a corto plazo. Los resultados obtenidos evidencian una diferencia sustancial en la distribucion de los valores del KDRI entre las poblaciones puertorriquena y estadounidense. Metodos: De los 377 rinones cadavericos donados a traves de LifeLink de Puerto Rico desde el 2009 al 2011, 187 rinones fueron trasplantados localmente. Se recogieron datos de los donantes de estos 187 rinones para calcular el KDRI. Los valores del KDRI fueron calculados usando el mismo metodo computacional utilizado en los Estados Unidos. La sobrevida del organo, la incidencia de rechazo mediada por anticuerpos y la prevalencia de infeccion con el virus de polioma BK (VBK) fueron examinadas en los recipientes. Resultados: El valor promedio de KDRI fue de 1.19. La distribucion de los valores de KDRI en la poblacion puertorriquena se desvia sustancialmente de la estadounidense. La sobrevida de la cohorte de organos donados fue de 89.6% a los 3 anos. La prevalencia de VBK en suero fue de 16.9%. De estos pacientes, 6.25% desarrollaron nefropatia, 46.2% desarrollaron anticuerpos especificos al donante de novo y 19.5% tenian estos anticuerpos anterior al trasplante. Conclusion: Nuestro estudio demuestra el papel que juegan las caracteristicas de la poblacion puertorriquena en la distribucion de los valores del KDRI. Esto puede sugerir que la identificacion de variables especificas a distintos grupos geograficos podria resultar en mejor clasificacion de donantes y prediccion de resultados.