{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T04:05:54Z","timestamp":1763179554825,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T00:00:00Z","timestamp":1712880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Renal Urological Multidisciplinary Research Group (GRUMUR) of the Salamanca Biomedical Research Institute (IBSAL, Instituto de Investigaci\u00f3n Biom\u00e9dica de Salamanca)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Introduction: The protocol for deceased donor kidney transplants has been standardised. The procedure for a living donor has peculiarities derived from the differences in the graft. When a living kidney donor program is implemented, changes occur in both the profile of the kidney transplant candidate and in the postoperative treatments. Aims: To discover whether a living donor program influences the functional outcomes of kidney grafts in a longstanding classical deceased donor kidney transplant program and to identify the factors associated with transplant outcomes. Methods: Retrospective observational multicentre study. Sample: Kidney transplant patients in two urology referral centres for renal transplant in Spain between 1994 and 2019. Groups: TV (living transplant): patients given kidney transplants from living donors (n = 150); TCpre11 (deceased transplant previous to 2011): patients given kidney transplants from deceased donors before the living donor program was implemented (n = 650); and TCpost11 (deceased transplant after 2011): patients given kidney transplants from deceased donors after the living donor program was implemented (n = 500). Results: Mean age was 55.75 years (18\u201380 years), higher in TCpre11. There were 493 female patients (37.92%) and 1007 male patients (62.08%). Mean body mass index (BMI) was 26.69 kg\/m2 (17.50\u201342.78 kg\/m2), higher in TCpre11. Mean ischemia time was 17.97 h (6\u201329 h), higher in TCpost11. Median duration of urethral catheter: 8 days (6\u201398 days), higher in TCpost11. Median duration of double-J ureteral stent: 58 days (24\u2013180 days), higher in TCpost11. Pretransplant UTIs: 17.77%, higher in TCpre11 (25.69%) than in TV (12%), higher in TV (12%) than TCpost11 (9.2%), and higher in TCpre11 (25.69%) than TCpost11 (9.2%). Acute renal rejection in 9.33% of TV, 14.77% of TCpre11, and 9.8% of TCpost11. Multivariate analysis: TCpost11 featured higher BMI, more smoking, and chronic renal failure progression time. Lower use of nonantibiotic prophylaxis to prevent recurrent urinary tract infections, increased duration of urethral catheters due to obstructive problems, and favoured deterioration of kidney function was observed in the deceased donor program. The living donor (LD) program had a strong influence on deceased donor transplants in the prelysis phase. Implementation of a LD program was associated with a decrease in the likelihood of acute rejection in TCpost11 and an increase in the tendency towards normal kidney function. Conclusions: Implementing living donor transplant programs affects functional outcomes in deceased donor transplants, reducing the probability of acute rejection and increasing the tendency towards normal kidney function. Preventing recurrent urinary tract infections with measures other than antibiotics, smoking cessation, delaying the removal of the double-J stent from the graft, and pre-emptive transplant (transplant prior to dialysis) are associated with improved renal function of the graft.<\/jats:p>","DOI":"10.3390\/jpm14040408","type":"journal-article","created":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T03:34:37Z","timestamp":1712892877000},"page":"408","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhancing Kidney Transplant Outcomes: The Impact of Living Donor Programs"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0829-0003","authenticated-orcid":false,"given":"Andrea","family":"Noya-Mourullo","sequence":"first","affiliation":[{"name":"Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain"},{"name":"Department of Surgery, University of Salamanca, 37007 Salamanca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandro","family":"Mart\u00edn-Parada","sequence":"additional","affiliation":[{"name":"Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Palacios-Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pablo","family":"Eguiluz-Lumbreras","sequence":"additional","affiliation":[{"name":"Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00d3scar","family":"Heredero-Zorzo","sequence":"additional","affiliation":[{"name":"Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Garc\u00eda-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Luis","family":"\u00c1lvarez-Ossorio-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Urology Department, Puerta del Mar University Hospital in C\u00e1diz, 11009 C\u00e1diz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"\u00c1lvarez-Ossorio-Rodal","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Salamanca, 37007 Salamanca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magaly-Teresa","family":"M\u00e1rquez-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Salamanca, 37007 Salamanca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1338-0551","authenticated-orcid":false,"given":"Javier","family":"Flores-Fraile","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Salamanca, 37007 Salamanca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pilar","family":"Fraile-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital of Salamanca, 37007 Salamanca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B\u00e1rbara Yolanda","family":"Padilla-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Urology Unit, Surgery Department, University of La Laguna, San Crist\u00f3bal de La Laguna, 38200 Santa Cruz of Tenerife, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda-Fernanda","family":"Lorenzo-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain"},{"name":"Department of Surgery, University of Salamanca, 37007 Salamanca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,12]]},"reference":[{"key":"ref_1","first-page":"78","article-title":"Prevalence of chronic renal disease in Spain: Results of the EPIRCE study","volume":"30","author":"Otero","year":"2010","journal-title":"Nephrology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1111\/ajt.14702","article-title":"An economic assessment of contemporary kidney transplant practice","volume":"18","author":"Axelrod","year":"2018","journal-title":"Am. J. Transplant."},{"key":"ref_3","unstructured":"Ministry-of-Health, Spanish Government (2023). Kidney Donation and Transplant Activity."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1177\/0003134820923312","article-title":"Outcomes With Age Combinations in Living Donor Kidney Transplantation","volume":"86","author":"Aslam","year":"2020","journal-title":"Am. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1177\/1526924819835803","article-title":"The Relationship Between Frailty and Decreased Physical Performance With Death on the Kidney Transplant Waiting List","volume":"29","author":"Lorenz","year":"2019","journal-title":"Prog. Transplant."},{"key":"ref_6","unstructured":"Lorenzo-G\u00f3mez, M.-F., Fraile-G\u00f3mez, M.-P., and Mac\u00edas-N\u00fa\u00f1ez, J.-F. (2021). Nephrology and Urology, Editions University of Salamanca. [1st ed.]."},{"key":"ref_7","unstructured":"Lorenzo-G\u00f3mez, M.-F., Fraile-G\u00f3mez, M.-P., and Mac\u00edas-N\u00fa\u00f1ez, J.-F. (2021). Nephrology and Urology, Editions University of Salamanca."},{"key":"ref_8","unstructured":"Ministry of Health, Social Services and Equality (2012). Royal Decree 1723\/2012, of December 28, Which Regulates the Activities of Obtaining, Clinical Use and Territorial Coordination of Human Organs Intended for Transplantation and Establishes Quality and Safety Requirements, \u00abBOE\u00bb num. 313."},{"key":"ref_9","unstructured":"University of Salamanca Healthcare Complex (2020). Memoire: Donation and Transplants Coordination, Health Counseling of Castilla y Leon."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1097\/MOT.0000000000000843","article-title":"Kidney and pancreas transplant candidacy","volume":"26","author":"Regmi","year":"2021","journal-title":"Curr. Opin. Organ. Transplant."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2321","DOI":"10.1016\/j.transproceed.2019.03.047","article-title":"Nursing Diagnoses and Interventions in Kidney Transplant Recipients: A Retrospective Study","volume":"51","author":"Koken","year":"2019","journal-title":"Transplant. Proc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1053\/ajkd.2000.9794","article-title":"Gender disparity in living renal transplant donation","volume":"36","author":"Zimmerman","year":"2000","journal-title":"Am. J. Kidney Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.4239\/wjd.v12.i9.1563","article-title":"Obesity and bariatric surgery in kidney transplantation: A clinical review","volume":"12","author":"Veroux","year":"2021","journal-title":"World J. Diabetes"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1111\/sdi.12109","article-title":"Kidney transplantation in the obese transplant candidates: To transplant or not to transplant?","volume":"26","author":"Pham","year":"2013","journal-title":"Semin. Dial."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/j.surg.2021.10.024","article-title":"Nonlinear relationship between body mass index and clinical outcomes after kidney transplantation: A dose-response meta-analysis of 50 observational studies","volume":"171","author":"Yin","year":"2022","journal-title":"Surgery"},{"key":"ref_16","first-page":"169","article-title":"Efficacy and safety of D-mannose (2 g), 24 h prolonged release, associated with Proanthocyanidin (PAC), versus isolate PAC, in the management of a series of women with recurrent urinary infections","volume":"71","author":"Rituman","year":"2018","journal-title":"Arch. Esp. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"104458","DOI":"10.1016\/j.micpath.2020.104458","article-title":"A middle east systematic review and meta-analysis of bacterial urinary tract infection among renal transplant recipients; Causative microorganisms","volume":"148","author":"Behzad","year":"2020","journal-title":"Microb. Pathog."},{"key":"ref_18","first-page":"58","article-title":"Effect of pretransplant dialysis modality on incidence of early posttransplant infections in kidney recipients","volume":"65","author":"Neretljak","year":"2011","journal-title":"Acta Med. Croatica"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/iju.14726","article-title":"Creatinine reduction ratio on postoperative day 2 predicts long-term outcomes after living donor kidney transplantation","volume":"29","author":"Kinoshita","year":"2022","journal-title":"Int. J. Urol."},{"key":"ref_20","first-page":"331","article-title":"Organ preservation","volume":"333","author":"Hicks","year":"2006","journal-title":"Methods Mol. Biol."},{"key":"ref_21","first-page":"2829","article-title":"Outcome of kidney transplantation between controlled cardiac death and brain death donors: A meta-analysis","volume":"127","author":"Ming","year":"2014","journal-title":"Chin. Med. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e177","DOI":"10.1097\/TXD.0000000000000680","article-title":"Impact of Cold Ischemia Time in Kidney Transplants From Donation After Circulatory Death Donors","volume":"3","author":"Kayler","year":"2017","journal-title":"Transplant. Direct"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.kint.2017.01.032","article-title":"Cold ischemia time up to 16 hours has little impact on living donor kidney transplant outcomes in the era of kidney paired donation","volume":"92","author":"Gill","year":"2017","journal-title":"Kidney Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1016\/j.transproceed.2019.12.052","article-title":"Impact of Cold Ischemia Time on Kidney Transplant: A Mate Kidney Analysis","volume":"52","author":"Caldas","year":"2020","journal-title":"Transplant. Proc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2170","DOI":"10.1016\/j.transproceed.2022.08.019","article-title":"Impact of Prolonged Cold Ischemia Time on One Year Kidney Transplant Outcomes","volume":"54","author":"Fletchinger","year":"2022","journal-title":"Transplant. Proc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1111\/tri.13406","article-title":"Outcomes of kidney transplant from deceased donors with acute kidney injury and prolonged cold ischemia time\u2014A retrospective cohort study","volume":"32","author":"Dube","year":"2019","journal-title":"Transpl. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1097\/TP.0000000000002309","article-title":"The Relationships Between Cold Ischemia Time, Kidney Transplant Length of Stay, and Transplant-related Costs","volume":"103","author":"Serrano","year":"2019","journal-title":"Transplantation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.transproceed.2019.12.049","article-title":"Prolonged Cold Ischemia Time Offsets the Benefit of Human Leukocyte Antigen Matching in Deceased Donor Kidney Transplant","volume":"52","author":"Vinson","year":"2020","journal-title":"Transplant. Proc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e928735","DOI":"10.12659\/AOT.928735","article-title":"Effect of Long Cold Ischemia Time of Kidneys from Aged Donors on Prognosis of Kidney Transplantation","volume":"26","author":"Liu","year":"2021","journal-title":"Ann. Transplant."},{"key":"ref_30","first-page":"316","article-title":"Evoluci\u00f3n de las causas de p\u00e9rdida del injerto en trasplante renal durante 40 a\u00f1os (1979\u20132019)","volume":"43","author":"Calatayud","year":"2021","journal-title":"Rev. Nefrol."},{"key":"ref_31","first-page":"532","article-title":"Double urinary bladder voiding technique post removal of urethral catheter in renal allograft recipients","volume":"18","author":"Zomorrodi","year":"2007","journal-title":"Saudi J. Kidney Dis. Transpl."},{"key":"ref_32","first-page":"cd011455","article-title":"Early versus late ureteric stent removal after kidney transplantation","volume":"1","author":"Thompson","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"118","DOI":"10.6002\/ect.2020.0249","article-title":"Outcomes of Early Simultaneous Removal of Ureteric Stent With Indwelling Urethral Catheter After Kidney Transplant in Pediatric Recipients: A 10-Year Review","volume":"19","author":"Ng","year":"2021","journal-title":"Exp. Clin. Transplant."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3411","DOI":"10.1016\/j.transproceed.2018.08.033","article-title":"Meta-analysis of Early Versus Late Ureteric Stent Removal After Kidney Transplantation","volume":"50","author":"Cai","year":"2018","journal-title":"Transplant. Proc."},{"key":"ref_35","first-page":"213","article-title":"Should ureteral catheterization be systematically used in kidney transplants?","volume":"35","author":"Broseta","year":"2011","journal-title":"Actas Urol. Esp."},{"key":"ref_36","unstructured":"Lorenzo, V., and L\u00f3pez G\u00f3mez, J.M. (2023, December 12). Available online: https:\/\/www.nefrologiaaldia.org\/336."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/14\/4\/408\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:26:46Z","timestamp":1760106406000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/14\/4\/408"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,12]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["jpm14040408"],"URL":"https:\/\/doi.org\/10.3390\/jpm14040408","relation":{},"ISSN":["2075-4426"],"issn-type":[{"type":"electronic","value":"2075-4426"}],"subject":[],"published":{"date-parts":[[2024,4,12]]}}}