LETTER TO THE EDITOR
Year : 2008 | Volume
: 19 | Issue : 6 | Page : 983--984
Can the principle of "LYFT" help objectively in timing renal transplantation therapy for the CKD patients?
Consultant Nephrologist, King Fahad Specialist Hospital, P.O. Box 15215, Dammam 31444, Saudi Arabia
Consultant Nephrologist, King Fahad Specialist Hospital, P.O. Box 15215, Dammam 31444
|How to cite this article:|
Abutaleb N. Can the principle of "LYFT" help objectively in timing renal transplantation therapy for the CKD patients?.Saudi J Kidney Dis Transpl 2008;19:983-984
|How to cite this URL:|
Abutaleb N. Can the principle of "LYFT" help objectively in timing renal transplantation therapy for the CKD patients?. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2021 Jan 22 ];19:983-984
Available from: https://www.sjkdt.org/text.asp?2008/19/6/983/43478
To the Editor,
Death with a functioning kidney is a well recognized cause for the loss of nearly half of the transplanted kidneys. This has recently stimulated UNOS to consider the estimation of the expected life years from transplant (LYFT) upon allocating kidneys from diseased donors. Patients with high LYFT values are expected to have priority especially toward receiving grafts with better quality. LYFT value expresses the increased life span (in years) because of receiving a kidney transplant from a particular donor. Its value is affected by multiple recipient and donor factors. It is calculated by using estimated survival years following transplant minus estimated survival years if remained on dialysis. Adjustment for quality of life was also suggested and carried out by multiplying survival on dialysis by a factor of 0.8. 
As no graft allocation problem exists in living donor transplantations, LYFT has not been yet calculated for this group. However, there are other potential benefits from estimating LYFT for the candidate of living donor transplantations, especially if LYFT calculation is carried out and monitored earlier during their late CKD stages. For those planned to receive a kidney from a specific known relative, donor factors as age and gender can be included in the estimation of LYFT at an early stage. The estimation of LYFT for the CKD patients prior to reaching ESRD, may pinpoint an earlier moment at which renal transplantation can be justified for its significant survival benefits over the survival on conservative approach.
Studies have revealed very high mortality for the CKD stages 3b to 5 (i.e. GFR 1.3% of the patients in stage 3 reached ESRD stage during this 5-year follow-up period. 2 Clearly such overall mortality rates of these CKD stages are already much higher than that of many renal transplant patients despite the fact that these transplant patients have reached ESRD prior to receiving their allografts. Furthermore, the survival of renal transplant patients receiving their renal graft at an earlier CKD stages would be significantly better than the available rates for the current renal transplant patients. Aborting uremia related organs' damage by earlier nephron supplement (i.e. transplantation) is likely to result in renal transplant patients with even lower over-all mortality rates. Data from preemptive renal transplantation where transplantation is carried out usually within CKD stage 5, is obviously supportive for this notion. As only living donor (mostly related) kidneys would be offered at CKD stages earlier to dialysis stage, patients' survival benefits are likely result in an even better utilizion of these ideal donors.
Based on available database, LYFT can, apparently, easily be computed for the living donor transplant candidates but at an ESRD stage at which renal transplantation is currently offered. As essentially no transplantation is carried out earlier to CKD stage 5, I suggest adopting currently available survival rates for the recipients of living donor kidneys, for the purpose of calculating LYFT at CKD stages earlier to stage 5. This would obviously underestimate LYFT values (survival benefit) when utilized for the CKD patients at stages earlier to stage 5.
On the other hand, building database for the CKD patients similar to that done for the ESRD patients on TX waiting list seems essential for more than just calculating LYFT values that I discuss here. Patients with such high mortality as CKD in stages 3b and beyond need such database to allow close analysis of the problem. Different cofactors contributing to such high mortality rates can be carefully weighed. This would allow accurate estimation of mortality rates for the individual CKD patient. These patients are not different from those dialysis patients listed on the deceased kidney waiting list. They are similarly heading toward receiving renal grafts or dying prior to such therapy. USRDS 2003 suggested that the probability of death in such patients is in fact 5 to 10 times that of receiving renal TX. 
Renal transplantation can then be appropriately offered for those CKD individuals at any stage once their calculated LYFT values become remarkably positive in favor of transplantation.
|1||OPTN web site: Kidney Allocation Policy Development reports and lectures.|
|2||Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004;164(6):659-63.|
|3||USRDS Annual Report 2003, Atlas of ESRD in the United States, page 38, lines: 23-24 (However, this was a quotation from USRDS 2002 Report).|