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'Nature vs. nurture' study of deceased donor pairs in kidney transplantation
April 22, 2009Minneapolis/St. Paul, MN -- The implications of a new study could improve the outcomes, and potentially survival rates, for some of the thousands of individuals who undergo kidney transplants each year. The study concluded that donor-related risk factors, yet to be identified, make a measurable contribution to the ultimate success or failure of a kidney transplant.
The study, "'Nature versus Nurture' Study of Deceased Donor Pairs in Kidney Transplantation," was supported by the Robert Wood Johnson Foundation Physician Faculty Scholars program and is to be published in the April 22nd online edition, and the June print edition, of the Journal of the American Society of Nephrology. It examines outcomes over a three-year period in pairs of kidney recipients, each of whom received a kidney from the same deceased donor.
The study found that when two recipients get their respective kidneys from a single deceased donor, certain so-called "unmeasured risk factors" in the donor can significantly contribute to both recipients' risk for two kinds of problems. The first problem is "delayed graft function" (DGF), or sluggish kidney function requiring a period of dialysis; the second is kidney failure.
According to Ajay Israni, M.D., M.S., lead author of the study, more research is needed to better understand what these "unmeasured risk factors" are. He added that changes are needed in public-health policy laws, so that when a patient's kidney fails, his or her provider is permitted to share that information with the provider whose patient received the partner kidney.
"If providers were allowed to share this critical information with each other, we could potentially increase survival rates by intervening with the surviving patients," Dr. Israni said. Examples of possible intervention strategies, he said, include an increase in monitoring and surveillance of the surviving patient, catching a potential kidney rejection before it gets out of control, and/or tailoring immunosuppressive drugs to reduce the possibility of rejection.
Dr. Israni is an Assistant Professor of Medicine and an Adjunct Assistant Professor of Epidemiology and Community Health at the University of Minnesota. He conducted the research as a member of the Robert Wood Johnson Physician Faculty Scholars program.
An additional finding of the study is that slight variations in medical procedures used at different transplant facilities had a less significant impact on kidney failure outcomes than the unmeasured risk factors did. However, transplant center procedures did have an effect on the rates of DGF. This finding suggests that there are variations in early post-transplant management at transplant centers that may be contributing to delayed kidney function.
Additional Study Information:
The study examined the risks of DGF and transplant failure within 19,461 recipient pairs having the same deceased donor and transplanted between 1995 and 2003, using data from the United States Renal Data System. It examined the within-pair correlation of these outcomes among recipients of kidneys from the same deceased donor, and adjusted for transplant center effect by estimating separate odds ratios (OR) for recipient pairs transplanted at the same transplant center and at different transplant centers. The authors detected the transplant-center effect by measuring the difference in outcomes for the paired kidneys from the same deceased donor transplanted at the same versus different centers.
Robert Wood Johnson Foundation Health & Society Scholars
According to Ajay Israni, M.D., M.S., lead author of the study, more research is needed to better understand what these "unmeasured risk factors" are. He added that changes are needed in public-health policy laws, so that when a patient's kidney fails, his or her provider is permitted to share that information with the provider whose patient received the partner kidney.
"If providers were allowed to share this critical information with each other, we could potentially increase survival rates by intervening with the surviving patients," Dr. Israni said. Examples of possible intervention strategies, he said, include an increase in monitoring and surveillance of the surviving patient, catching a potential kidney rejection before it gets out of control, and/or tailoring immunosuppressive drugs to reduce the possibility of rejection.
Dr. Israni is an Assistant Professor of Medicine and an Adjunct Assistant Professor of Epidemiology and Community Health at the University of Minnesota. He conducted the research as a member of the Robert Wood Johnson Physician Faculty Scholars program.
An additional finding of the study is that slight variations in medical procedures used at different transplant facilities had a less significant impact on kidney failure outcomes than the unmeasured risk factors did. However, transplant center procedures did have an effect on the rates of DGF. This finding suggests that there are variations in early post-transplant management at transplant centers that may be contributing to delayed kidney function.
Additional Study Information:
The study examined the risks of DGF and transplant failure within 19,461 recipient pairs having the same deceased donor and transplanted between 1995 and 2003, using data from the United States Renal Data System. It examined the within-pair correlation of these outcomes among recipients of kidneys from the same deceased donor, and adjusted for transplant center effect by estimating separate odds ratios (OR) for recipient pairs transplanted at the same transplant center and at different transplant centers. The authors detected the transplant-center effect by measuring the difference in outcomes for the paired kidneys from the same deceased donor transplanted at the same versus different centers.
Robert Wood Johnson Foundation Health & Society Scholars
Kidney Transplantation Current Events and Kidney Transplantation News RSSSwitching immunosuppressants reduces cancer risk in kidney
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Older kidney transplant patients should more often consider live donors
Almost half of kidney transplant candidates older than 60 who are put on the waiting list for a deceased-donor organ will die before getting a transplant.
Kidney transplant survival can be long-term for people with HIV
A Johns Hopkins study finds that HIV-positive kidney transplant recipients could have the same one-year survival rates for themselves and their donor organs as those without HIV, provided certain risk factors for transplant failure are recognized and tightly managed.
African-American Canadians who receive kidney transplants fare better than those in US
African American kidney disease patients in both Canada and the United States are less likely than Caucasian Americans to have access to kidney transplants, but only African-Americans in the United States have worse health outcomes than Caucasians after a transplant is performed.
Study Shows Steroid Therapies Following Transplant Can Be Eliminated
A new study by researchers at UC shows that using modern immunosuppressive drugs eliminates the need for steroid therapy as early as seven days following a transplant surgery while still maintaining kidney function
Annual Report Targets Chronic Kidney Disease in the United States
A 30 percent increase in chronic kidney disease over the past decade has prompted the U.S. Renal Data System (USRDS) to issue for the first time a separate report documenting the magnitude of the disease, which affects an estimated 27 million Americans and accounts for more than 24 percent of Medicare costs.
New protocol streamlines therapy that makes more kidney transplants possible
A new therapy developed at Cedars-Sinai Medical Center improves transplant rates and outcomes for patients awaiting living- and deceased-donor kidney transplantation, according to a study published in the July 17 issue of the New England Journal of Medicine.
Anti-rejection drug may increase risk of diabetes after kidney transplant
For patients undergoing kidney transplantation, treatment with the anti-rejection drug sirolimus may lead to an increased risk of diabetes, reports a study in the July Journal of the American Society of Nephrology (JASN).
Race, insurance status affect access to transplantation and kidney disease treatment
Universal access to health care might help to overcome racial and ethnic barriers to treatment for kidney disease, suggest two studies in the March 2008 issue of Clinical Journal of the American Society of Nephrology.
Kidney donor age linked to aortic siffening
Transplantation of kidneys from older donors is followed by increased stiffening of the recipient's aorta-which may help to explain the higher rates of cardiovascular disease and death in patients receiving kidneys from "expanded criteria" donors, reports a study in the April Journal of the American Society of Nephrology.
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