Presentation on theme: "FORECASTING ONE-YEAR RENAL ALLOGRAFT FUNCTION AND SURVIVAL Yuriy Yushkov 1, Nikolina Icitovic 1, Ruslan Fedkiv 1, and Michael J. Goldstein 1,2 (1)New York."— Presentation transcript:
FORECASTING ONE-YEAR RENAL ALLOGRAFT FUNCTION AND SURVIVAL Yuriy Yushkov 1, Nikolina Icitovic 1, Ruslan Fedkiv 1, and Michael J. Goldstein 1,2 (1)New York Organ Donor Network, New York, NY, (2) Mount Sinai Medical Center, New York, NY. ISODP 2011 Buenos Aires, Argentina
Material and Method Aim: To identify donor and renal allograft parameters that can be utilized in predicting renal transplant one-year graft function and survival Method: we performed retrospective analysis of renal allograft outcomes of1176 deceased donor kidneys. All kidneys were transplanted in the NYODN Donor Service Area. Allografts were evaluated using machine measured renal resistance (MMRR) and optimized needle renal biopsy technique. Allografts were divided into three groups by MMRR ( 0.3). Donor age, gender, race, type (SCD/ECD/DCD), eGFR (MDRD), renal biopsy (glomerulosclerosis (GS), tubular interstitial scarring (TIS), vascular fibrous narrowing (VN), as well as MMRR were correlated with one-year graft function and survival. Kaplan-Meier curves, Log-rank tests were used to investigate the relationship between MMRR at 1.5, 3 and 5 hours ( 0.3) and one-year graft function and survival. For 954 allografts multifactorial Cox regression analysis was used to reveal the relationship among donor characteristics, biopsy parameters and MMRR at 1.5, 3 and 5 hours ( 0.3).
DONOR CHARACTERISTICS Graft Status up to 1 year Freq.% Functioning108692.35% Failed907.65% Total1176100 Donor RaceFrequencyPercent Amer Ind/Alaska Native30.26 Asian423.57 Black23419.90 Hispanic23119.64 Multiracial121.02 White65455.61
Correlation among one year graft survival, age, gender and race
The absence of correlation between donors’ e-GFR (MDRD) and MMRR e-GFR p= 0.372 Resistance @3 hrs<3030-60>60Total <0.270150245465 15.0532.2652.69100 44.8746.4452.4649.15 0.2-0.362126164352 17.6135.846.59100 39.7439.0135.1237.21 >0.3244758129 18.636.4344.96100 15.3814.5512.4213.64
Correlation between MMRR at 3 hours and one-year renal allograft survival
Correlation between MMRR at 5 hours and one-year renal allograft survival
Correlation between MMRR and one year graft eGFR (MDRD)
Correlation between MMRR and three year graft eGFR (MDRD) P<0.0001
P=0.002 P=0.160 Correlation among predicted probabilities of higher MMRR and GS, TIS and Vascular Narrowing P=0.035 P=0.087 P=0.015 High MMRR for TIS Odds Ratio: TIS 11-25%: 1.23 TIS 26-50%:4.06 High MMRR for VN Odds Ratio: IVN 11-25%: 1.25 IVN 26-50%:1.67 High MMRR for GS Odds Ratio 1.02
Conclusion 1.MMRR together with renal allograft biopsy should be utilized to evaluate the quality of a donated kidney. 2.MMRR can be used to predict the probability of a one-year, two and three year of renal graft function and graft failure. 3.Renal pathology parameters such as GS and TIS showed a linear relationship with MMRR.
KIDNEY ASSESSMENT TOOLS Donor clinical assessment and lab data Allograft Renal Biopsy performed using Optimized Needle Biopsy Technique (ONBT) (1,2) Biopsy frozen section evaluation performed by a single Transplant Pathology Lab 24h/7days a week 1.Total number of glomeruli/number of obsolete glomeruli 2.Tubular interstitial scarring (%) 3.Intimal fibrous narrowing of arteries (%) 4.Presence of ATN, inflammation Machine preservation 1. Renal resistance/flow value (at 1,5 h, 3h, 5h) 1.An Approach to Needle Biopsy Technique to Improve Glomerulus Yield. Y. Yushkov, F.W. Selck, and the Kidney– Pancreas Committee of the New York Organ Donor Network, Transplantation Proceedings, 40, 1051–1053 (2008) 2.Optimized Technique in Needle Biopsy Shown to Be of Greater Sensitivity and Accuracy Compared to the Wedge Biopsy. Y. Yushkov, S. Dikman, J. Alvarez-Casas et al. Transplantation Proceedings, 42, 2493-2497 (2010)
An Approach to Needle Biopsy Technique to Improve Glomerulus Yield. Y. Yushkov, F.W. Selck, and the Kidney–Pancreas Committee of the New York Organ Donor Network, Transplantation Proceedings, 40, 1051–1053 (2008) Mann-Whitney test: ONBT results reported significantly more tubular interstitial scarring, intimal fibrous narrowing, (p<0.001, p<0.001). BIOPSY TECHNIQUE
Correlation between MMRR and allograft survival RES. 5hTOTALFAILEDCensoredCensored% <0.25284248692.05 0.2-0.33844134389.66 >0.3115199683.48 TOTAL102710292590.07 RES. 3hTOTALFAILEDCensoredCensored% <0.25224248091.95 0.2-0.34064236489.66 >0.31482312584.46 TOTAL107610796990.06