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"Compared with living donors aged 50 to 70 years, donor age older than 70 years may be a negative predictor of kidney transplant and graft survival, according to a presentation at the American Transplant Congress."


This finding could have an effect on living donor eligibility at some transplant centers.

Donor-reported barriers to living kidney donor follow-up
Babak J. Orandi, Rhiannon D. Reed, Haiyan Qu, Grace Owens, Sydney Brooks, A. Cozette Killian, Vineeta Kumar, Saulat S. Sheikh, Robert M. Cannon, Douglas J. Anderson, Cora E. Lewis, Jayme E. Locke … See fewer authors
First published: 19 February 2022 https://doi.org/10.1111/ctr.14621

Despite regulations mandating follow-up laboratory testing for living kidney donors, less than half of transplant centers are in compliance. We sought to understand barriers to follow-up testing from the donors’ perspective.
We surveyed our center's living kidney donors. Binary logistic regression was used to assess factors associated with follow-up testing completion.
Of 185 living kidney donors, 110 (59.4%) participated. Among them, 82 (74.5%) completed 6-month laboratory testing, 76 (69.1%) completed 12-month testing, 68 (61.8%) completed both, and 21 (19.0%) completed neither. Six-month testing completion was strongly associated with 12-month testing completion (OR 9.74, 95%CI: 2.23-42.50; p = .002). Those who disagreed with the statements, “Getting labs checked wasn't a priority for me,” (OR for completing 6-month testing: 15.05, 95%CI: 3.70-61.18; p < .001; OR for completing 12-month testing: 5.85, 95%CI: 1.94-17.63; p = .002); and, “I forgot to get labs drawn [until I was reminded]” (OR for completing 6-month testing: 6.93, 95%CI: 1.59-30.08; p = .01; OR for completing 12-month testing: 6.55, 95%CI: 1.98-21.63; p = .002) were more likely to complete testing.
To our knowledge, this is the only study providing perspective on donor insights regarding the need for follow-up testing post donation. Interventions to influence living donor attitudes toward follow-up testing may improve follow-up.

Three-Time Living Organ Donor Hopes to Inspire Others to Donate
Robin Stanley

Anthony Cernera has dedicated his professional life to helping others as director of philanthropy for St. Vincent’s Medical Center in Bridgeport. In 2015, when he saw a friend post on Facebook about donating a kidney to a friend’s son, he saw the opportunity to make it part of his personal life as well.
“She said, ‘I’m going to do this thing that’s going to be a little inconvenient for me for a few days, but I’m going to save somebody’s life,’” Cernera recalled.
Inspired by that friend, Cernera has since made three living organ donations – a kidney to a stranger named Lance in 2016, followed by stem cells to a leukemia patient in 2017, and most recently, a portion of his liver to another stranger, Martin, in 2020.


Complications After Hand-Assisted Laparoscopic Living Donor Nephrectomy
Benavides, MD, Richard T. Rogers, MD, Ek Khoon Tan, MBBS, MPH, FRCSEd, Patrick G. Dean, MD, Mikel Prieto, MD, Mark D. Stegall, MD, et al.
 Mayo Clinic Proceedings
 Published:April 25, 2022


To study the complications of hand-assisted laparoscopic living donor nephrectomy (HALLDN) with an emphasis on complications occurring early after hospital discharge up to 120 days after surgery.
Patients and Methods
We retrospectively categorized complications using the Clavien-Dindo classification in 3002 HALLDNs performed at 1 center from January 1, 2000, through December 31, 2019. In addition to overall summaries, modeling was used to identify correlates of complications before and after living donation.
Of these donors, 87% were White, 59% were female, the mean age was 45 years (range, 18-77 years), 30.3% had a body mass index of at least 30, and 36.3% had previous abdominopelvic surgery. There were no deaths related to the surgery. The incidence of major complications (intraoperative complications plus Clavien-Dindo grade ≥III postoperatively) was 2.5% (n=74). The overall complication rate was 12.4% (n=371), including 15 intraoperative, 76 postoperative before discharge, and 280 after discharge to 120 days. Reoperation was required in 1.8% of patients (n=54), and all but 1 of these were incision-related problems. Seventy-six percent of all complications occurred after discharge, including 85% of the reoperations. For major complications, no risk factor was found. Risk factors for any complication included paramedian incision (hazard ratio

, 2.54; 95% CI, 1.49 to 4.34; P<.001); a history of abdominopelvic surgery (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), male sex (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), non-White race (HR, 1.40; 95% CI, 1.05 to 1.88; P=.02), and early era of the experience.[/font][/size]
Most major complications of HALLDN occur after discharge, suggesting that close follow-up is warranted and that the current literature may underestimate the true incidence.

[Full text available, worth reviewing.-Clark]


OPTN/SRTR 2020 Annual Data Report: Preface
American Journal of Transplantation
Volume22, IssueS2
Special Issue: OPTN/SRTR Annual Data Report 2020
March 2022
Pages 1-10
First published: 10 March 2022 https://doi.org/10.1111/ajt.16975

This Annual Data Report of the US Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR) is the 30th annual report and is based on data pertaining to the period 2009-2020. The title OPTNISRTR 2020 Annual Data Report reflects the fact that the report covers the most recent complete year of transplants, those performed in 2020.
This publication was developed for the US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation, by the SRTR contractor, Hennepin Healthcare Research Institute (HHRI), and the OPTN contractor, United Network for Organ Sharing (UNOS), under SRTR contract HHSH75R60220C00011, and OPTN contract HHSH250201900001C.
As the SRTR contractor, HHRI, through its Chronic Disease Research Group (CDRG), determined which data to present, conducted the required analyses, created the figures and tables, and drafted the text. As the OPTN contractor, UNOS reviewed the draft report and contributed to the content. This report is available at srtr. transplant.hrsa.gov. Individual chapters, as well as the report as a whole, may be downloaded.
Overview and Highlights
This Annual Data Report includes chapters on kidney, pancreas, liver, intestine, heart, and lung transplants, as well as chapters on deceased organ donation, the SRTR Living Donor Collective, vascular composite allograft (VCA) transplant, and COVID-19. The organ-specific chapters include information on such topics as the waiting list, deceased donor organ donation, living donor organ donation, transplant, outcomes, and pediatric transplant. When possible, similar data and formats are used for each chapter. However, this is not always possible because some data are not pertinent to all organs.
Graphical presentation of the data is emphasized: more than 600 figures, tables, and maps are included in the chapters. They may be copied and pasted from the HTML files into slides….

OPTN/SRTR 2020 Annual Data Report: Kidney

OPTN/SRTR 2020 Annual Data Report: Living Donor Collective

Living Donation in the News / Rethinking incompatibility in kidney transplantation
« Last post by Clark on April 22, 2022, 09:42:56 AM »

Rethinking incompatibility in kidney transplantation
American Journal of Transplantation
Volume22, Issue4
April 2022
Pages 1031-1036
Kyle R. Jackson, Dorry L. Segev
First published: 31 August 2021 https://doi.org/10.1111/ajt.16826

Donor/recipient incompatibility in kidney transplantation classically refers to ABO/HLA-incompatibility. Kidney paired donation (KPD) was historically established to circumvent ABO/HLA-incompatibility, with the goal of identifying ABO/HLA-compatible matches. However, there is a broad range of donor factors known to impact recipient outcomes beyond ABO/HLA-incompatibility, such as age and weight, and quantitative tools are now available to empirically compare potential living donors across many of these factors, such as the living donor kidney donor profile index (LKDPI). Moreover, the detrimental impact of mismatch at other HLA antigens (such as DQ) and epitope mismatching on posttransplant outcomes has become increasingly recognized. Thus, it is time for a new paradigm of incompatibility that considers all of these risks factors together in assessing donor/recipient compatibility and the potential utility for KPD. Under this new paradigm of incompatibility, we show how the LKDPI and other tools can be used to identify donor/recipient incompatibilities that could be improved through KPD, even for those with a traditionally "compatible" living donor.


First clinical-grade porcine kidney xenotransplant using a human decedent model
Paige M. Porrett, Babak J. Orandi, Vineeta Kumar, Julie Houp, Douglas Anderson, A. Cozette Killian, Vera Hauptfeld-Dolejsek, Dominique E. Martin, Sara Macedon, Natalie Budd, Katherine L. Stegner, Amy Dandro, Maria Kokkinaki, Kasinath V. Kuravi, Rhiannon D. Reed, Huma Fatima, John T. Killian Jr., Gavin Baker, Jackson Perry, Emma D. Wright, Matthew D. Cheung, Elise N. Erman, Karl Kraebber, Tracy Gamblin, Linda Guy, James F. George, David Ayares, Jayme E. Locke
American Journal of Transplantation
Volume22, Issue4
April 2022
Pages 1037-1053
First published: 20 January 2022 https://doi.org/10.1111/ajt.16930

A radical solution is needed for the organ supply crisis, and the domestic pig is a promising organ source. In preparation for a clinical trial of xenotransplantation, we developed an in vivo pre-clinical human model to test safety and feasibility tenets established in animal models. After performance of a novel, prospective compatible crossmatch, we performed bilateral native nephrectomies in a human brain-dead decedent and subsequently transplanted two kidneys from a pig genetically engineered for human xenotransplantation. The decedent was hemodynamically stable through reperfusion, and vascular integrity was maintained despite the exposure of the xenografts to human blood pressure. No hyperacute rejection was observed, and the kidneys remained viable until termination 74 h later. No chimerism or transmission of porcine retroviruses was detected. Longitudinal biopsies revealed thrombotic microangiopathy that did not progress in severity, without evidence of cellular rejection or deposition of antibody or complement proteins. Although the xenografts produced variable amounts of urine, creatinine clearance did not recover. Whether renal recovery was impacted by the milieu of brain death and/or microvascular injury remains unknown. In summary, our study suggests that major barriers to human xenotransplantation have been surmounted and identifies where new knowledge is needed to optimize xenotransplantation outcomes in humans.
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